1. Nebraska Rural Health Conference April 24th-25th, 2019
Federal Office of Rural Health Policy Update: The Current State of Rural Health
Nebraska Rural Health Conference
April 24th-25th, 2019

2. Health Resources and Services Administration Overview
HRSA supports more than 90 programs through grants and cooperative agreements to more than 3,000 awardees
HRSA provides access to health care for people who are:
Geographically isolated
Economically or medically challenged
HRSA programs serve tens of millions of people every year, including:
Pregnant women, mothers and their families
People living with HIV/AIDS
People living in rural communities
Those otherwise unable to access quality health care

3. Health Resources and Services Administration Overview
Eleven million people living in health professional shortage areas receive primary medical, dental or mental health care from a National Health Service Corps clinician in the past year.
Over 61 million pregnant women and children in the U.S. supported by the Maternal and Child Health Block Grant.
More than 160,000 parents and children served by the Home Visiting Program
Nearly 26 million people receive primary medical, dental, or behavioral health care from a health center. One in four rural residents gets care from a health center.
One in 2 people diagnosed with HIV receives care through the Ryan White HIV/AIDS Program.

4. Federal Office of Rural Health Policy
State and Hospital Programs
State Offices of Rural Health, Flex and Small Rural Hospital Improvement Programs, Rural QI TA, Small Rural Hospital Transitions
Community Based Programs
Black Lung, Delta, Opioids, Care Coordination, Network Development and Planning, Quality Improvement, Outreach
Telehealth Programs
Telehealth Resource Centers, Network Grants, Licensure Portability, Rural Child Poverty, Rural Veterans Health Access
Policy and Research
Rural Health Research Centers, Rural Health Value, Rural Policy Analysis, RHC Policy and Clinical Assessment
New in 2018 & 2019: Rural Community Opioids Response Programs and Rural Residency Programs

5. The Federal Office of Rural Health Policy
Charged with advising the Secretary on how current and proposed Medicare and Medicaid policies impact rural areas, about the ability of rural areas to attract and retain health professionals, and about the access to and quality of healthcare in rural areas
FORHP is the voice for rural within the Department of HHS

6. Resources to Know….. www.ruralhealthresearch.org

7. What Does Access to Care Look Like in Rural Communities?

8. Rural Health Workforce Realities
The Federal Office of Rural Health Policy Health Resources and Services Administration
Rural Health Workforce Realities
Physicians
MDs/DOs 5.5/10K non metro vs. 7.9/10K in metro
All Primary Care
MD/DO/NP/PA 11.6/10K in non metro vs. 16.2/10K in metro
Dentists
3.6/10K non metro vs. 5.9/10K in metro
Dental Hygienists
4.5/10K in non metro vs. 5.0/10K in metro
Source: WWAMI Rural Health Resource Center

9. Rural Health Workforce Realities
The Federal Office of Rural Health Policy Health Resources and Services Administration
Rural Health Workforce Realities

10. Availability of Behavioral Health Providers

12. Rural Hospital Closures
104 rural hospitals have closed as of yesterday morning, including Tilden Community Hospital in 2014.
Closed hospital is defined as a facility that stopped providing general, short-term acute inpatient care
Some closed hospitals stop providing services altogether but some, like Tilden, continue to provide a mix of services other than inpatient care

13. The Federal Office of Rural Health Policy Health Resources and Services Administration

14. The Federal Office of Rural Health Policy Health Resources and Services Administration

15. Maternal Health – Access to OB Services
Between 2004 and 2014:
The percent of rural counties with hospital-based obstetrics services declined from 55% to 46%.
179 rural counties (9% of all rural counties) lost access to in-county hospital obstetric services.
Women living in rural noncore counties (areas with less than 10,000 residents) were disproportionately affected by the loss of hospital obstetric services.
Only 30.2% of rural noncore counties had continual hospital obstetric services compared to 77.9% of micropolitan counties.

16. Access to OB Services
So What Happens After Communities Lose OB Services?
In the year after loss of services rural counties not adjacent to
urban areas had significant increase in:
Out-of-hospital births
Births in a hospital without obstetric services
Preterm births
In the year after loss of services rural counties adjacent to urban areas had significant increase in:
Kozhimannil KB, Hung P, Henning-Smith C, Casey MM, Prasad S. Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the US. JAMA. 2018;319(12):

17. Access to Obstetrical Services
Rural Maternity and Obstetrics Management Strategies Program (RMOMS)
The RMOMS pilot program intends to demonstrate the impact on access to and continuity of maternal and obstetrics care in rural communities.
Up to three cooperative agreements
4-year award
Year 1 is for planning activities (up to $600,000)
Years 2 through 4 are for implementing activities (up to $800,000)
TA Webinar:
April 30, 2019
Application Deadline:
May 24, 2019

18. Pharmacy Closures
1,231 (16%) independently owned rural pharmacies closed
631 rural communities that had at least one retail (independent, chain or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018

19. Tracking ACO Coverage in Rural Areas

20. Scope of Practice

21. Rural Health Disparities

22. Life Expectancy at Birth (Years) by Levels of Rurality, United States, 2010-2014
Source: Singh GK, Siahpush M. American Journal of Preventive Medicine. 2014;46(2):e19-e29 (updated data)

23. Potentially Excess Death
In 2015, a higher rate of potentially excess deaths occurred among rural Americans than urban Americans from:
Heart disease
More than 26,700 excess deaths
43.6% in rural areas; 27.9% in urban areas
56% higher in rural areas than urban
Cancer
More than 18,800 excess deaths
Overall cancer deaths declined between
declined less in rural (1% per year) vs. large urban areas (1.6% per year)
Unintentional injuries
More than 13,200 excess deaths
59.6% in rural areas; 43.5% in urban areas
37% higher in rural areas than urban
Chronic lower respiratory disease
More than 11,600 excess deaths
56.0% in rural areas; 31.9% in urban areas
75% higher in rural areas than urban 23

24. Suicide Mortality

25. Chronic Obstructive Pulmonary Disease
Limited Access to Respiratory Therapy
COPD Underdiagnosed
Significant Driver in Costly Re-Admissions

26. Cancer Average Annual Age-Adjusted Rates of New Cases of Common Cancers ( ) and Deaths from Common Cancers ( )
Overall, nonmetro rural areas had lower incidence rates but higher death rates
Some variation by type of cancer

27. Addressing the Opioid Epidemic

28. Addressing the Opioid Epidemic

29. Addressing the Rural Opioid Challenge
Unique Challenges:
Limited Infrastructure
Access to Needed Services (MAT, DEA-waivered Clinicians, etc.)
Stigma
Scale
The Rural Community Opioids Response Program:
Build on Lessons Learned from Early Program Investments
Rural Opioid Overdose Reversal Program
Rural Health Opioids Program
Executive and Legislative Branch Support
2018: $130 Million
$30 Million for Loan Repayment
2019: $120 Million

30. Collaborating for Rural Across HHS

31. The challenge…. The concern….
How will rural providers with special payment types designed to maintain access to services in rural and underserved communities fully participate in new payment models?
The concern….
That the very payment policy provided to maintain access in rural and underserved communities may now undermine participation in innovative care delivery and payment models going forward…
….and ultimately undermine access to services in those rural and underserved communities.

32. CMS Rural Health Strategy
Apply a rural lens to CMS programs and policies
Improve access to care through provider engagement and support
Advance telehealth and telemedicine
Empower patients in rural communities to make decisions about their health care
Leverage partnerships to achieve the goals of the CMS Rural Health Strategy

33. Rural Involvement in CMS Innovation Center Models and Programs
Rural-Relevant Models
Medicare Shared Savings Program
ACO Investment Model
Comprehensive Primary Care Plus
Accountable Health Communities (AHC) Model
Frontier Community Health Integration Project
Regional multi-payer concepts, e.g., global budgeting (MD, PA)

34. Rural Focus at Centers for Disease Control (CDC)

36. Connecting with HRSA

37. HRSA Needs Your Help Become a HRSA Grant Reviewer

38. FORHP Weekly Announcements
Rural-focused Funding Opportunities
Policy and Regulatory Developments Affecting Rural Providers and Communities
Rural Research findings
Policy updates from a Rural Perspective
To sign up: Michelle Daniels at

40. Contact Information
Sarah Heppner
Director – Policy Research Division
Kerri Cornejo
Policy Coordinator
Federal Office of Rural Health Policy (FORHP) Health Resources and Services Administration (HRSA)
Phone:
Web: 40

41. To learn more about our agency, visit
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