Rural Spotlight

Deadline Extension for Telemedicine Standards

Due to a recent proposed telemedicine rule change made by CMS, the Joint Commission’s July 15th deadline for general and critical access hospitals implementation of telemedicine standards has been stretched to March 2011. The extension offers providers additional time to meet Medicare’s telemedicine credentialing and privileging requirements.

The deadline was extended in response to a perception that the July 15 date negatively affected the ability of providers to offer telehealth services. The Joint Commission will comment on the proposed rule by July 26th. Read more here. 

Scoring the Social Mission of Colleges

Recent research has found that some colleges and universities are more likely to promote physicians working in underserved areas. The regions and specific locations of the schools had a great impact on their social mission scores.  Read an article on the research by clicking here.

Updated Reports

PubHub has made the following reports available:

Training Strategies: EHR Deployment Techniques
 
Based on the California Networks for Electronic Health Record Adoption (CNEA) initiative designed to speed EHR implementation in safety-net clinics, explores approaches to training, their influence on implementation strategy, and streamlining effects.

HITECH Revisited
 
Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies.
 
Standardized Performance Measurement and Reporting in Emergency Departments (EDs)
 
Describes the RWJF-funded Urgent Matters Learning Network, a collaborative of six hospitals working to develop strategies to improve patient flow and reduce crowding. Outlines seven standardized performance measures they are piloting and reporting on.

Payment Reform: Creating a Sustainable Future for Medicaid
 
Outlines elements of Medicaid payment reform that saves costs while improving access to quality care, including accommodating patient acuity, encouraging data collection, and supporting medical homes, bundled payments, and accountable care organizations.

Pediatric Care in Rural Hospital Emergency Departments

Two new publications are available from the North Carolina Rural Health Research & Policy Analysis Center that analyzed data from the Emergency Pediatric Services and Equipment Supplement(EPSES) to the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rural and urban hospitals’ responses on various dimensions of pediatric ED care. Aso surveyed, were 65 ED directors at rural hospitals in a separate process to explore rural pediatric ED care in more detail and to obtain the opinion of rural ED administrators regarding ways to assure quality emergency care for children.

Findings Brief #96 "Pediatric Care in Rural Hospital Emergency Departments"

The full report, Final Report #97 "Pediatric Care in Rural Hospital Emergency Departments"

Key findings from this study include:

Analysis of the EPSES data using a comprehensive definition of rural and urban found the following:
Rural hospitals had a lower ED visit volume and were less likely to be teaching hospitals or to have a children’s hospital in their county. They were also less likely to be Level I (highest) or Level II Trauma Centers. Rural hospitals had less access to physicians trained in emergency medicine, in pediatrics, or in pediatric emergency medicine. Rural hospitals had a lower overall score than urban hospitals on an inventory of 131 pediatric emergency supplies and equipment. However, the percent of all supplies that were available in rural hospitals was only 5.1 percentage points less than the percent available in urban hospitals.

Hospitals in our survey of rural hospital ED directors were similar to those in the EPSES rural panel. Findings include the following:

ED staff in every hospital had access to a medication chart for pediatric dosages and most had a special pediatric emergency cart. Few, however, had a special room in their ED for pediatric care. The availability of board-certified pediatricians and emergency medicine physicians was higher than in the EPSES rural sample. Most ED physicians or mid-level providers had Advanced Cardiac Life Support (ACLS) training and most hospitals reported that all of their ED physicians or mid-levels had Pediatric Advanced Life Support (PALS) training. Most rural hospitals reported that some or all ED nurses had PALS training. Many reported that some or all nurses had completed the Emergency Nursing Pediatric Course and most had some nurses with Trauma Nursing Core Curriculum training. Staff training was the most common need reported. Money to pay for training was the biggest barrier. Also cited was lack of training opportunities and staffing to cover when others were at training.

Rural Care and Mental Health Services

The Maine Rural Health Research Center has recenlty released a report on Rural Health Clinics (RHCs) that offer mental health services and those that might in the future.  Click here to read the paper that includes the research findings.  It includes barriers to implementing mental health services in RHCs, and suggestions for doing so.

Medical Programs Looking for Diversity

The path to a career in medicine doesn't always take a traditional route. The Washington Post recently published the story of one medical student who is becoming a doctor after getting some practical experience while serving in the military. She, along with others, are being recruited by schools looking for students with a wider range of backgrounds.

Rural Hospital Provisions

The American Hospital Association has provided a brief summary of the rural hospital related provisions of The Patient Protection and Affordable Care Act. Click here to read the summary.  

Japanese Efforts Could Make Way Around Globe

Recent efforts in Japan to retain physicians in rural areas has other nations watching their technique to see if it will work for them. Click here to read an article about how Japan has overcome a physician shortage that was leaving their rural citizens without care.

Medicaid Expansion and Performance Research

PubHub has made the following reports available:

Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL
 
Estimates state and national cost increases from the 2010 health reform law's expansion of Medicaid to adults under age 65 with incomes up to 133 percent of the federal poverty line, in relation to enrollment increases under two outreach scenarios.

Enhancing the Capacity of Community Health Centers to Achieve High Performance
 
Based on a survey of community health centers, assesses access to care, care coordination, quality improvement efforts, health information technology adoption, and ability to serve as patient-centered medical homes. Suggests policy to strengthen clinics.

CMS Funding Opportunities

The Centers for Medicare and Medicaid Services (CMS) has made two funding opportunities available to states. The first is a demonstration project that will assess the ability of patient-centered "medical homes" to improve primary care delivery and lower health care costs. The Multi-payer Advanced Primary Care Practice Demonstration will include Medicare, Medicaid and private insurers and use a team approach to care that emphasizes prevention, health information technology, care coordination and shared decision making among patients and providers. Participating practices will receive an enhanced payment for their Medicare patients commensurate with other participating payers. CMS will accept applications through Aug. 3 and expects to award cooperative agreements to six states. For more information, click here. 

The second opportunity is with PPACA grants available to help patients navigate their health care options. CMS and Administration on Aging will accept applications through July 30 for $60 million in Patient Protection and Affordable Care Act grants to help people navigate their health and long-term care options. The agencies will jointly award the funds in September to states, area agencies on aging, State Health Insurance Assistance Programs, and Aging and Disability Resource Centers. The funds will be used to help underserved individuals understand their Medicare and Medicaid benefits; provide support for people with disabilities to live at home or other settings they choose; help people transition from the hospital or nursing home back to the community; and strengthen links between the medical and social service systems.