Health Status and Health Care Access of Farm and Rural Populations

Check out this new report by the Economic Research Service that was released last week! This report focuses on the health status and health care access of members of the Nation’s rural households and farm-operator households in comparison with those of urban and nonfarm households.

Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts, though mortality and disability rates vary more by region than by metro status. Contributing negatively to the health status of rural residents are their lower socioeconomic status, higher incidence of both smoking and obesity, and lower levels of physical activity. Contributing negatively to the health status of farmers are the high risks from workplace hazards, which also affect other members of farm families who live on the premises and often share in the work; contributing positively are farmers’ higher socioeconomic status, lower incidence of smoking, and more active lifestyle. Both farm and rural populations experience lower access to health care along the dimensions of affordability, proximity, and quality, compared with their nonfarm and urban counterparts.

Click here to download the full report

Medicare Payment Policies for Telehealth Services

CMS has recently published a brochure on its Medicare payment policies for Telehealth services. The following link will take you to the brochure:
http://www.cms.hhs.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

Practicing Excellence: A small-town, rural doctor embraces technology

Here is one small rural doctor's experience with Electronic Health Records!

Practicing medicine takes on a different feel when you're the only doctor in town. But Jim Selenke, MD, the lone physician in Hudson, Iowa, wouldn't have it any other way.

"The rural practitioner has to be incredibly confident in his skills and able to address the unpredictable," says Selenke, a family physician. "You have a lot less control over your schedule. Patients often walk in unannounced with a wide variety of ailments."

One man hurt himself while securing a load to his truck and showed up at Selenke's door with the metal hook of a bungee cord still stuck in his eyelid. There was the elderly woman whose car veered off the road near Selenke's practice before a passerby brought her—unresponsive and without a pulse—to his office. In the midst of performing a well-baby exam, Selenke dashed outside, intubated the woman, and performed CPR before an ambulance arrived to stabilize her.

But patient care is only part of Selenke's job. He handles the landscaping outside his practice, fixes its plumbing, maintains his office computer systems—he even changed the tire on a patient's car recently, a deed that was rewarded with a batch of what he calls the best cookies around.

"In primary care and in a small town, if you want to survive, you put on multiple hats," says Selenke, who is known to everyone in town as "Dr. Jim."

Rural patients tend to be older, poorer, less likely to have private insurance, and more likely to suffer serious injury from accidents compared to their urban counterparts, according to the National Rural Health Association. Plus, Medicare reimbursement tends to be lower, and providers are harder to come by, ratcheting up the pressure on those who serve such areas.

For the most part, Selenke's patient population mirrors the trends typical of rural America: About 40 percent of his 4,000 patients are on Medicare. He practices five days a week and manages to see about 35 patients per day.

He keeps up that prodigious pace with help from his electronic health record system, an investment he made five years ago when he first opened his own practice. He also decided then to maximize his efficiency and lower his overhead by teaching himself what he needed to know to maintain his IT systems. Though going high-tech—and mostly going it alone—was a choice few others in his shoes would likely make, it has made all the difference for Selenke.

Read more...

Taking the Pulse of Rural Health Care

New health information technologies hold promise for improving health care in remote areas.

Reforming the U.S. health care system is high on the national policy agenda. Debate over U.S. health policy has focused on expanding health insurance coverage, improving the quality of health care, and reducing costs. These three goals are interrelated because lack of insurance coverage and poor coordination of services across care providers tend to drive up costs.

Within this broader context, rural households confront special health care challenges due to their lower socioeconomic status, higher average age, and greater geographic dispersal than the U.S. population as a whole. Rural households, on average, have less education and fewer financial resources, both of which are associated with lower health status. Approximately 15 percent of rural residents (compared with 12 percent of urban residents) are age 65 or older, which leads to a greater incidence of chronic disease and disability. Lower population densities in rural areas mean that residents must typically travel longer distances for health services, especially for specialty care.

Read more...

Congratulations to the Shenandoah Area Agency on Aging!

The Shenandoah Area Agency on Aging in Front Royal, VA was honored at the National Association of Area Agencies on Aging (n4a) conference for their "At Home" program, that provides chronic disease management and support to rural homebound seniors.

The National Association of Area Agencies on Aging (n4a) announced the recipients of the 2009 n4a Aging Innovations and Achievement Awards at its annual conference in Minneapolis, MN. This awards program recognizes n4a members and showcases innovative and successful aging services programs that assist older adults and caregivers in communities across the country. The need for successful cost–effective aging services programs is especially important in light of our rapidly growing aging population.

Fifty-three programs received Aging Achievement Awards, of which 16 were honored with Aging Innovations Awards. In addition, the four programs that scored the highest in the review process received monetary awards. Jeffrey Prough, President and CEO of Critical Signal Technologies (CST), sponsor of the awards program, announced the following monetary awards: $2,500 to Tarrant County Area Agencies on Aging (Ft. Worth, TX) for Diabetes Identification and Management Program, a partnership with the local Meals on Wheels program that enables diabetic seniors to receive monthly diabetic education in their homes; $1,500 to Region IV Area Agency on Aging (St. Joseph, MI) for Custom Care—Care Connections of Southwest Michigan, a private pay options to help AAAs respond to customers who are able to pay for customized attention to their needs; $1,500 to the Oklahoma Association of Area Agencies on Aging (Shawnee, OK) for O4A Masonic Assistance Program for Seniors, a program that leverages local resources to fund direct assistance that help older adults maintain their independence; and $1,000 to the Central Plains Area Agency on Aging (Wichita, KS) for Client Assessment Program for Seniors (CAPS), a program that offers free professional in-home mental health assessment and counseling.

“As a company that believes in innovations, CST is thrilled to be involved with the Aging Innovations and Achievement Awards program because we know that the solutions to the aging services needs and challenges all lie in the innovation initiatives at the local level,” Prough said.

The Aging Innovations Awards recognize ground-breaking programs that are innovative and bring fresh ideas to aging programs. The honored programs serve as models for other agencies looking for new approaches to serve the older population within their own communities.

“Area Agencies on Aging (AAAs) and Title VI Native American aging programs are the trusted resources for assistance to older adults and caregivers in their communities. These organizations are the lifeline that provide critical resources that help older adults remain in their homes and stay active and contributing members of their communities as long as possible,” stated Sandy Markwood, n4a CEO.

Sixteen Aging Innovations Awards, the highest honor, were presented to the following:

Shenandoah Area Agency on Aging/Front Royal, VA for At Home – (a program that provide chronic disease management and support to rural homebound seniors)

Alliance for Aging, Inc./Miami, FL for Team Miami: A Community Partnership for Evidence-Based Solutions to Improving Elders’ Health – (a collaborative initiative that addresses the issues of elder Hispanic health disparities)

Central Plains Area Agency on Aging/Wichita, KS for Client Assessment Program for Seniors (CAPS) – (a program that offers free professional in-home mental health assessment and counseling to eligible participants)

Tarrant County Area Agency on Aging/Ft. Worth, TX for Diabetes Identification and Management Program – (a partnership with the local Meals on Wheels program that enables diabetic seniors to receive monthly diabetic education in their homes)

Region IV Area Agency on Aging/St. Joseph, MI for Costume Care—Care Connections of Southwest Michigan – (a private pay option to help AAAs respond to customers who are able to pay for customized attention to their needs)

Elder Services of the Merrimack Valley/Lawrence, MA for Enhanced Supportive Homemaker Program – (a program that increases the capability of homemakers to work with elders who have difficult behaviors)

REAL Services, Inc./Area 2 Agency on Agency/South Bend, IN for Options Counseling and Pre-Screening – (a program that offer long-term care information and education about options to nursing home care)

Aging & Disability Resource Center of Broward County/Sunrise, FL for Senior Intervention and Education Program (SIEP) – (an outreach initiative that evaluates the independent living environment of homebound and isolated seniors)

Southern Maine Agency on Aging/Scarborough, ME for Community Links – (this program offers assistance to older adults being discharged back into the community with unmet physical and social needs)

Area Agency on Aging of Palm Beach/Treasure Coast, Inc./West Palm Beach, FL for Jupiter HeadStart Godparent Program – (volunteer godparents provide resources and assistance to children from low-income families)

InterTribal Council of Arizona, Inc.—Area Agency on Aging/Phoenix, AZ for ITCA-AAA Public Benefits Outreach Project – (a program that educates and counsels tribal elders and individuals with disabilities about Medicare and public benefits)

Generations, Area 13 Agency on Aging/Vincennes, IN for Long Term Care Team – (Case managers work to insure resources and referrals for older discharged patients)

Area Office on Aging of Northwestern Ohio/Toledo, OH for Expedited Meal Delivery for Our Seniors – (program utilizes UPS expertise to delivery nutrition meals to homebound seniors)

Bergen County Division of Senior Services/Hackensack, NJ for Outreach Volunteer Associates Program – (this program advocates for Asian-American seniors and helps them learn about and access available resources)

Metropolitan Area Agency on Aging/St. Paul, MN for Dementia Care Project – (a systems change initiative to increase the detection, diagnosis and care management of dementia)

Oklahoma Association of Area Agencies on Aging/Shawnee, OK for O4A Masonic Assistance Programs for Seniors – (a program that leverages local resources to fund direct assistance that help older adults maintain their independence)

In addition, the 2009 Aging Achievement Awards were given to 37 programs in 14 categories that included caregiving, community planning, ethnic and cultural diversity, elder abuse, healthy aging, intergenerational programs, nutrition, technology, transportation and volunteerism/civic engagement.

The National Association of Area Agencies on Aging (n4a) is the umbrella organization for 629 Area Agencies on Aging (AAAs) and a voice for the 246 Title VI Native American aging programs in the U.S. The fundamental mission of the AAAs and Title VI aging programs is to provide services that make it possible for older individuals to remain in their homes, thereby preserving their independence and dignity. These agencies coordinate and support a wide range of home and community-based services, including information and referral, home-delivered and congregate meals, transportation, employment services, senior centers, adult day care and a long-term care ombudsman program. (www.n4a.org).

Taken from RAC News and Events

Commonwealth Fund Case Studies Highlight High-Performing Health Systems - This One in Rural Wisconsin

Marshfield Clinic is a physician-governed multispecialty group practice in rural Wisconsin that has engaged physicians and staff in a program of clinical performance improvement aimed at enhancing patient access, coordination of care, and efficiency of clinical operations. Marshfield's telemedicine network expands access to care for patients living in rural and remote areas.

Letter to the Editor by Dr. Benjamin Brown, Blue Ridge Medical Center

Taken from the News & Advance:

Until most people feel strongly that health care needs to be changed for reasons larger than their own personal insurance plan, health care is unlikely to be reformed meaningfully.

I am a family physician practicing locally. I personally believe in a principle that everybody in America should have health insurance, just as everyone’s children deserve an education. Furthermore, I believe we are already paying for those without health insurance, via the most inefficient means possible, emergency room visits and cost shifting from people with insurance plans.

However, there are other forces pressuring our country, caused by the high cost of health care, that have very immediate and personal consequences to someone in everyone’s family. Sixty-two percent of personal bankruptcies are due to medical costs according the recent American Journal of Medicine article. This is primarily happening to people who have health insurance policies. American jobs are being lost to overseas companies because of the cost of American health care. Companies are laying off workers because of the cost of health insurance, and jobs are hard to find. A large percentage of recent foreclosures have resulted from medical debt. These economic trends drop the value of people’s life savings, which they count on for retirement and emergencies.

If we don’t take advantage of the momentum to change health care in this country now, I firmly believe that, as a country, we will be forced back to this table again soon, with a deeper and more complicated situation on our hands. We can’t afford not to address our current inefficient health insurance system

Dr. BENJAMIN BROWN
Blue Ridge Medical Center
Arrington

Health Care Stories: Western Mass

Could this story have been written about rural Virginia? What do you think? What's different? What's the same?

Taken from: http://bootynovelbill.blogspot.com/2009/08/health-care-stories-western-mass.html

Paula gives us her assessment of rural care in the only state of the Union that requires everybody has health coverage.

Although we each certainly tried our best to burn out at a young age, my husband and I believe we are healthier than many of our contemporaries. He’s 69 and I’m 65. So far, so good. Aside from some predictable conditions that accompany normal aging, we’re fine and hope to keep it that way for a long, long time.

That said, I don’t resent paying for health care. Like most worker bees, I paid for insurance throughout my working days and well into semi-retirement. While I worked for a newspaper, I paid anywhere from 10 to 25 percent of my insurance premium. Later, as a freelancer, I bought my own policy for $615 a month for a mid-level HMO plan, purchased at a discount through a business association. Without group rates, I probably would have paid closer to $900 for an individual policy. That’s per month.

When I was young, single, and had an employer subsidizing my health insurance, I lived near New York City, an area blessed with an abundance of medical resources. There must have been a dozen hospitals in my county alone, and specialists were plentiful. Coincidentally, I was treated for one of each on the menu of all those things you-hope-you never-get. In every single case, I sought out the best medical care available, no matter where it was or what the cost. I had no fear of my insurer not coming up with the goods.

Now, I’m older, married, and self-employed, living in a much poorer, rural area. We each pay about $220 for a combination of Medicare and Medicare supplement, which includes prescription drugs. Compared to what we paid before we qualified for Medicare, it’s a pittance. Plus, under Medicare, our co-pays are smaller. Life is good.

Considering my unhealthy youth, I’m thrilled to say that, at 65, I’m relatively fit and healthy. A hearty thank you to all the docs who’ve treated me over the years, and to the health care plans that paid them.

It’s no exaggeration when I say I owe my current healthy state to good doctoring, prevention, and a strong dose of fear. A couple of scares in my early 50s forced me to get my body under control. Now, the only pills I take on a regular basis are vitamins and occasional OTC pain medication for arthritis.

In this household, we adhere to the Mediterranean diet as much as possible, and we’ve been buying the bulk of our food from local farmers for years. That’s an accident of location, not a political statement. Maybe the best thing my husband and I do for ourselves is spend a few mornings a week at the local YMCA, fending off old age.

In spite of relative good health, my biggest concern involves lack of resources. Where we live, there’s only one hospital (and ER) per county, and that one doesn’t offer a high level of care. Most towns have volunteer ambulance corps. If you think you might want to switch primary care physicians, think again because it’s hard to find one willing to take on a new patient. People often travel 40 miles or more to see a specialist, and they may wait for months for an appointment. That's just the way it is, because there are so few docs and so many old people. You have to work hard to stay healthy, and that's probably a good thing. (According to the obits, many people around here live well into their 80s and 90s. Could be the cold weather, or just the hard life.)

It’s my understanding that Medicare and our Blue Cross/Blue Shield supplement will cover our care at a high-level medical center – Massachusetts General Hospital, for example – if it's necessary and our primary care physician refers us. We’ll see.

I should add that the doctors we do have here out in the hinterlands are accessible, well-trained, and devoted to their patients. They’d have to be, because they work long hours and receive much lower compensation than they would if they practiced near a big city.

Paula
Western Massachusetts

The Rural America At A Glance Series

The Rural America At A Glance series highlights the most recent indicators of social and economic conditions in rural areas for use in developing policies and programs to assist rural areas. Reports in this series use current social and economic data to highlight population, labor market, income, and poverty trends in rural areas. The reports provide information on key rural conditions and trends for use by public and private decisionmakers and others in efforts to enhance the economic opportunities and quality of life for rural people and their communities.

In this series...
Rural America At A Glance
2008 (EIB-40)
2007 (EIB-31)
2006 (EIB-18)
2005 (EIB-4)
2004 (AIB-793)
2003 (RDRR-97-1)
2002 (RDRR-94-1)
Rural Broadband At A Glance (EIB-47)
Rural Children At A Glance (EIB-1)
Rural Education At A Glance (RDRR-98)
Rural Employment At A Glance (EIB-21)
Rural Hispanics At A Glance (EIB-8)
Rural Transportation At A Glance (AIB-795)
Rural Poverty At A Glance (RDRR-100)

Limited Number of Health Equity Conference Scholarships Available

The partners and sponsors of the 2009 Health Equity Conference are pleased to offer a limited number of conference scholarships to cover the cost of registration. The purpose of these scholarships is to encourage interested individuals to attend the conference who may not be able to attend for financial reasons. Scholarships will be awarded on a first come, first served basis.

The Health Equity Conference is scheduled for September 10 and 11, 2009 at the Cultural Arts Center in Glen Allen, Virginia. Individuals that want to attend the conference but are unable to pay the registration fee should apply for a scholarship as soon as possible. This can be done by going to the conference website located at http://www.virginiahealthequityconference.com/scholarships.htm and completing the scholarship application process.

Do You Qualify for a $63,750 Medicaid EHR Bonus?

Funding Comes Courtesy of Federal Stimulus Package

By Sheri Porter

A new report estimates that as many as 45,000 office-based physicians who participate in Medicaid and use electronic health records, or EHRs, could collect as much as $63,750 paid out over a six-year period as part of the American Recovery and Reinvestment Act of 2009.

Notably, about 9,800 primary care physicians — defined by report authors as family physicians, internists and general practitioners — could qualify for the bonuses.

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment was issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, an arm of George Washington University’s School of Public Health and Health Services in Washington.

The report provides insight into federal EHR funding efforts, according to Leighton Ku, Ph.D., M.P.H., professor of health policy at George Washington University and one of four report authors. He said the team wanted to research the little-explored Medicaid payout because it pays significantly more money than the $44,000 maximum provided by a similar Medicare program.

Ku noted that HHS’ bonus payment rules prevent “double dipping” from the Medicare and Medicaid programs. But “If you’re eligible for both (programs),” said Ku, “you’re probably better off taking the Medicaid money.”

HHS is anxious to expedite EHR implementation and is investing $49 billion in the two programs to help ensure that 40 percent of America’s physicians are up to speed with health information technology by 2012.

That goal may be difficult to attain. According to 2006 data from the National Ambulatory Medical Care Survey, only 15 percent of U.S. physicians have fully implemented EHRs; another 16 percent have begun the implementation process, and 69 percent do not use an EHR system.

Medicaid Bonus Criteria

To receive the Medicaid bonus, physicians must meet criteria beyond using a certified EHR. For example, to qualify for the full bonus, at least 30 percent of a physician’s patient panel must be enrolled in Medicaid.

Physicians who practice in federally qualified health centers or rural health clinics have less stringent criteria — they need only claim that 30 percent of their patients are “needy individuals.” As such, the patients must be covered by Medicaid, provided with free care or billed on a sliding-fee scale.

The authors point out that “after-the-fact debt forgiveness is not sufficient to classify a provider as one who serves ‘needy’ patient who are uncovered by Medicaid.”

Read more...

Small Area Health Insurance Estimates Released

The U.S. Census Bureau released an update to their model-based Small Area Health Insurance Estimates (SAHIE) today. This release provides state and county-level estimates of uninsurance by age, sex, and <= 200 percent of the Federal Poverty Level. More information on these estimates is available at the SAHIE web site.

Smaller Rural Hospitals Face Unique Health IT Challenges, Report Finds

The following is taken from an article from iHealthBeat:

Although most small rural hospitals are eager to adopt health IT tools, many have encountered difficulty in procuring products that suit their particular needs, according to a new report from research firm KLAS, Healthcare IT News reports.

The report, titled "Closing the IT Gap: Critical Access to 50 Bed Hospitals," incorporates feedback from more than 300 health care providers at hospitals with 50 or fewer beds.

The report found that most critical access facilities were eager for greater health IT system functionality, particularly in areas such as computerized physician order entry.

Of the surveyed facilities, only 21 have active CPOE systems, the report found.

The report identified CPSI, Healthland and HMS as the three vendors with the greatest market share for critical access hospitals.

Although Healthland received the highest performance rating, only 55% of customers reported satisfaction with Healthland's electronic health record system, said Paul Pitcher, KLAS research director and author of the report.

Pitcher added that only about 50% of physician comments were positive for the functionality and upgrade capabilities of the EHR products. He said these ratings suggest "significant gaps with the current offerings."

The report also noted that small rural hospitals will face the same deadlines for complying with federal "meaningful use" standards, despite a lack of adequate health IT systems for such facilities (Monegain, Healthcare IT News, 8/3).

Save the Date - 2009 VRHA/VAFC Joint Conference at the Homestead Resort!

Adopt a Rural Health Plan Recommendation

Who?

Anyone, individual or organization/agency! If you are already working on some aspect of one or more of these recommendations, or are considering doing so in any capacity, we NEED you to sign up!

Why? What am I Committing to Do?

By signing up to adopt a recommendation, you are committing to:

• Let us and others know what you are doing!
• Provide us with periodic updates about your efforts and give us permission to let others know.

That’s all! Simple, right?

Please sign up to adopt one or more of these recommendations.