FCC’s Performance Management Weaknesses Could Jeopardize Proposed Reforms of the Rural Health Care Program

Telemedicine offers a way to improve health care access for patients in rural areas. The Federal Communications Commission’s (FCC) Rural Health Care Program, established in 1997, provides discounts on rural health care providers’ telecommunications and information services (primary program) and funds broadband infrastructure and services (pilot program). GAO was asked to review (1) how FCC has managed the primary program to meet the needs of rural health care providers, and how well the program has addressed those needs; (2) how FCC’s design and implementation of the pilot program affected participants; and (3) FCC’s performance goals and measures for both the primary program and the pilot program, and how these goals compare with the key characteristics of successful performance goals and measures. GAO reviewed program documents and data, interviewed program staff and relevant stakeholders, and surveyed all 61 pilot program participants with recent participation in the program.

What GAO Recommends

GAO recommends that the FCC Chairman assess rural health care providers’ needs, consult with knowledgeable stakeholders, develop performance goals and measures, and develop and execute sound performance evaluation plans. In its comments, FCC did not agree or disagree with the recommendations, but discussed planned and ongoing actions to address them.

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Medicare Pays Almost Half of Rural Hospital Stays

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Newswise — Medicare patients accounted for almost half of all stays (45 percent) at rural hospitals in 2007, while the percentage of Medicare beneficiaries who were admitted to urban hospitals was considerably lower (35 percent) , according to the latest News and Numbers from the Agency for Healthcare Research and Quality.

The federal agency’s analysis also found that in 2007:

• About 25 percent of rural hospital patients were covered by private health insurance v. 36 percent of urban hospital patients. One-fifth of patients in both rural and urban hospitals had Medicaid and about 5 percent were uninsured.
• Half of the nation’s 2,000 rural hospitals had fewer than 50 beds compared with only one-fifth of urban hospitals.
• The top five illnesses among the two-thirds of rural residents who were hospitalized in rural facilities were: pneumonia (267,000 stays); congestive heart failure (166,000 stays); chronic obstructive lung disease (146,000 stays); chest pain (110,000); and fluid and electrolyte disorders, primarily dehydration and fluid overload (106,000 stays).
• The top five illnesses among the one-thirds of rural residents who were admitted to urban hospitals were hardening of the arteries (108,000 stays; osteoarthritis (79,000 stays); back disorders (75,000 stays); medical device, implant or graft complications (61,000 stays); and heart attack (61,000 stays).

This AHRQ News and Numbers is based on data in Inpatient Stays in Rural Hospitals, 2007 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb85.pdf). The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.

For Elderly in Rural Areas, Hard Times Get Harder - NYTimes.com

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By KIRK JOHNSON

Norma Clark, 80, slipped on the ice out by the horse corral one afternoon and broke her hip in four places. Alone, it took her three hours to drag herself the 40 yards back to the house through snow and mud, after she had tied her legs together with rope to stabilize the injury.

A dutiful farm wife, Ms. Clark somehow even got to her feet to latch the gate. And her first call when she got to the house was not to 911, but to a daughter 30 miles away.

“I told her she’d better come feed the horses,” said Ms. Clark, telling the story from her living room overlooking her 900-acre wheat farm.

Growing old has never been easy. But in isolated, rural spots like this, it is harder still, especially as the battering ram of recession and budget cuts to programs for the elderly sweep through many local and state governments.

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H.R. 3896: To amend title XVIII of the Social Security Act to improve access to health care for individuals... (GovTrack.us)

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To amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas, and for other purposes.

Sponsor: Rep. Jo Ann Emerson [R-MO8]
Cosponsors:

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Status:
Introduced Oct 21, 2009
Referred to Committee on Ways & Means

Updated Information

OVW FY 2009 Rural Domestic Violence, Dating Violence, Sexual Assault and Stalking Assistance Program

The Violence Against Women and Department of Justice Reauthorization Act of 2005 (VAWA 2005) expanded the scope of the Rural Domestic Violence, Dating Violence, Sexual Assault and Stalking Assistance Program (Rural Program) to include sexual assault and stalking, and modified the eligibility criteria as well as the statutory purpose areas under which projects must be implemented. The Rural Program recognizes that child, youth and adult victims of domestic violence, dating violence, sexual assault and stalking living in rural jurisdictions face unique barriers to receiving assistance and additional challenges rarely encountered in urban areas. The geographic isolation, economic structure, particularly strong social and cultural pressures, and lack of available services in rural jurisdictions significantly compound the problems confronted by those seeking support and services to end the violence in their lives and complicate the ability of the criminal justice system to investigate and prosecute domestic violence, dating violence, sexual assault and stalking cases. In addition, socio-cultural, economic, and geographic barriers create difficulties for victim service providers and other social services professionals to identify and assist victims of these crimes. The primary purpose of the Rural Program is to enhance the safety of child, youth and adult victims of domestic violence, dating violence, sexual assault, and stalking by supporting projects uniquely designed to address and prevent these crimes in rural jurisdictions. OVW welcomes applications that propose innovative solutions for achieving this goal. The Rural Program challenges victim advocates, law enforcement officers, pre-trial service personnel, prosecutors, judges and other court personnel, probation and parole officers, and leaders of faith-based and community organizations to collaborate to overcome the problem of domestic violence, dating violence, sexual assault, and stalking and to ensure that victim safety is paramount in providing services to victims and their children.

Expected Number of Awards: 57

Award Ceiling: $900,000

Data Collection Tool for State Offices of Rural Health Grant Program

The State Offices of Rural Health Grant Program (SORH) is authorized by Section 338J of the Public Health Service Act (42 U.S.C. 254r). The purpose of SORH is to assist States in strengthening their rural health care delivery systems by helping to support a focal point for rural health within each State. The program provides funding for an institutional framework that links rural hospitals, providers and communities with State and Federal resources to help develop long term solutions to rural health problems. The average annual award for each State based grantee is $150,000. The law provides for a Federal-State partnership, requiring a State funding match of $3 for each $1 of Federal funding. Over the past 16 years, this program has leveraged in excess of $200 million in State matching funds for rural health. For SORH, program performance measures were drafted to provide data useful to the program and to enable HRSA to provide aggregate program data required by Congress under the Government Performance and Results Act (GPRA) of 1993. ORHP seeks to collect information from grantees on their efforts to provide technical assistance to clients within their State. SORH grantees would be required to submit a Technical Assistance Report that includes: 1) The total number of technical assistance encounters provided directly by the grantee; and, 2) the total number of clients that received direct technical assistance from the grantee. Submission of the Technical Assistance Report would be done via e-mail to ORHP no later than 30 days after the end of each twelve month budget period.

Multi-Family Rural Housing Preservation Demonstration Program

The Rural Housing Service of Rural Development announces the availability of funds and the timeframe to submit applications for loans to private non-profit organizations, or such non-profit organizations' affiliate loan funds and State and local housing finance agencies, to carry out a demonstration program to provide revolving loans for the preservation and revitalization of low-income Multi-Family Housing (MFH). Housing that is assisted by this demonstration program must be financed by Rural Development through its MFH loan program under Sections 515, 514 and 516 of the Housing Act of 1949. The goals of this demonstration program will be achieved through loans made to intermediaries. The intermediaries will establish their programs for the purpose of providing loans to ultimate recipients for the preservation and revitalization of low income Sections 515, 514 and 516 MFH as affordable housing.

Veterans' Rural Health Advisory Committee; Notice of Meeting

The purpose of the Committee is to advise the Secretary of Veterans Affairs on health care issues affecting enrolled veterans residing in rural areas. The Committee will examine programs and policies that impact the provision of VA health care to enrolled veterans residing in rural areas, and discuss ways to improve and enhance VA services for these veterans. The meeting will feature remarks and presentations by the Secretary ofbVeterans Affairs, the Under Secretary for Health, the Assistant Deputy Under Secretary for Health for Policy and Planning, VA Office of Rural Health managers and staff, and select Veterans Health Administration program offices.

Advisory Committee on Interdisciplinary, Community-Based Linkages

The Committee will be focusing on rural issues and how the Title VII Interdisciplinary, Community-Based Training Grant Programs identified under sections 751-756, Part D of the Public Health Service Act can respond to the current rural healthcare workforce needs. The Committee has invited speakers to highlight various topics related to rural healthcare workforce issues including, but not limited to, discipline specific shortages; recruitment and retention; health professions training; faculty development; telemedicine; and other specific rural health care issues. The meeting will afford committee members with the opportunity to identify and discuss the current status of the healthcare workforce in rural America and formulate appropriate recommendations to the Secretary and to the Congress regarding a variety of training strategies to address the health workforce shortage issues. Agenda: The ACICBL agenda includes an overview of the Committee's general business activities, presentations by experts on rural healthcare workforce related issues, and discussion sessions specific for the development of recommendations to be addressed in the Eighth Annual ACICBL Report. Dates and Times: September 10, 2008, 11 a.m.-4 p.m., EST., September 11, 2008, 11 a.m.-4 p.m., EST. Place: (Web Conference). Status: The meeting will be open to the public; Web conference access limited only by availability of telephone ports.

Shortage of Rural Docs in Maryland Predicted

The state association of doctors is saying that Marylanders who live in rural areas may soon see a shortage of doctors to treat them:

• The report, known as the Maryland Physician Workforce Study, concludes that a shortage of doctors in rural Maryland is likely to worsen significantly by 2015 as older physicians retire and new ones choose to practice elsewhere....
• The report ... recommends various legislative remedies, including higher physician reimbursement rates by insurers, medical malpractice reforms and a loan-forgiveness program to attract young physicians to regions most in need.