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RHIhub This Week - October 2, 2019

Models and Innovations

Bike AJO program logo Bike Ajo
To increase physical activity levels, the Bike Ajo Coalition in rural Arizona has a comprehensive program for adults and youth, which provides bicycle helmets, repairs, community rides, an after-school bike program, and education.

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 Information from around the web

Recent News

As Rural Suicide Rates Increase in America, Studies Show Risk is Not Randomly Distributed
Sep 30, 2019 -- Opinion piece by Dr. Carrie Henning-Smith, deputy director of the University of Minnesota Rural Health Research Center, provides an overview of a study that investigated nearly half a million suicides in the U.S. between 1999 and 2016. Results show some people are at a higher risk, specifically those in rural areas, listing social isolation and lack of health insurance as some of the factors leading to the increase in suicide rates.
Source: NBC

CMS: Agency Information Collection Activities: Proposed Collection; Comment Request
Sep 30, 2019 -- The Centers for Medicare and Medicaid Services is seeking public comment on a proposed information collection titled "Hospital Survey for Specified Covered Outpatient Drugs (SCODs)." Data submitted by hospitals during this information collection will be used to determine payment amounts for drugs acquired under the 340B program. Comments are due by November 29, 2019.
Source: Federal Register

CMS: Medicare and Medicaid Programs: Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies, and Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care
Sep 30, 2019 -- Notice of final rule from the Centers for Medicare and Medicaid Services to revise discharge planning requirements that hospitals, Critical Access Hospitals, and home health agencies participating in the Medicare and Medicaid programs must meet. Also implements discharge planning requirements to provide patients and their families with access to information that will help them make informed decisions about post-acute care, and updates a provision regarding patient rights which is intended to promote innovation and flexibility to improve patient care. The final rule will be effective on November 29, 2019.
Source: Federal Register

CMS: Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital (CAH) Changes to Promote Innovation, Flexibility, and Improvement in Patient Care
Sep 30, 2019 -- Notice of final rule from the Centers for Medicare and Medicaid that removes unnecessary and burdensome regulations, reduces requirements that impede or divert resources away from providing high quality care, and updates fire safety standards for End-State Renal Disease (ESRD) facilities participating in the Medicare and Medicaid programs. Also updates the requirements that hospitals and Critical Access Hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. Includes implementation dates for CAHs related to Quality Assessment and Performance Improvement Programs (QAPI) and for hospitals and CAHs related to antibiotic stewardship programs. The final rule will be effective on November 29, 2019.
Source: Federal Register

Rural Hospital Closings Reach Crisis Stage, Leaving Millions Without Nearby Health Care
Sep 30, 2019 -- Addresses the widespread closings of hospitals in rural America and the impact they have on surrounding communities. Includes information on common challenges seen across the country and alternative models of care being tested.
Source: The Conversation

Why Rural Hospitals Keep Closing Maternity Wards
Sep 30, 2019 -- Rural hospitals across Iowa have decided to close their labor and delivery units due to an aging population and shifting healthcare needs. Examines the difficult decision that several hospitals have had to make in order to keep their facilities from closing altogether.
Source: Side Effects Public Media

Rural Hospitals in Michigan Face a Dilemma: Merge or Not?
Sep 29, 2019 -- Addresses one rural Michigan medical center's decision to sell to a larger healthcare system and shut down its obstetrics unit. Includes the opinions of local community members and hospital administrators, as well as an overview of the healthcare gaps in the state.
Source: Bridge

'Out Here, It's Just Me': In the Medical Desert of Rural America, One Doctor for 11,000 Square Miles
Sep 28, 2019 -- Explores the vast medical desert in west Texas as one man is the only doctor to care for three remote counties. Contains examples of the many patients he sees in a given day and identifies what it takes to recruit and retain physicians in rural areas. (May require a subscription).
Source: The Washington Post

Without Insurance, Man's Life Hangs in Balance
Sep 28, 2019 -- Features a rural Texan in need of complex life-saving surgery, but many local hospitals with the capability to help him, refuse his transfer as he does not have insurance. Discusses the limits of patient protections when it comes to emergency care and the expense of employer-offered insurance. (May require subscription to view).
Source: Victoria Advocate

CDC Update: Lung Disease Associated with E-cigarette Use or Vaping
Sep 26, 2019 -- The Injury Center at the Centers for Disease Control and Prevention (CDC) has released an update regarding the lung disease linked to E-cigarettes and vaping. Includes a media advisory and resources for healthcare providers and local health departments.
Source: The Centers for Disease Control

In Township Ravaged by Opioids, Educators Create Program to Help Kids Cope
Sep 25, 2019 -- Summarizes an interview with a teacher and a psychologist at a school district in Minford, Ohio. The school started a program to help children of parents or grandparents dealing with addiction manage their emotions and navigate trauma.
Source: WBUR

Funding & Opportunities

340B Drug Pricing Program
Allows certain facilities, such as Critical Access Hospitals and Federally Qualified Health Centers and FQHC Look-Alikes, to purchase prescription and non-prescription medications at reduced cost.
Geographic coverage: Nationwide and U.S. Territories
Application Deadline: Oct 15, 2019
Sponsors: Health Resources and Services Administration, Office of Pharmacy Affairs, U.S. Department of Health and Human Services

National Health Service Corps Students to Service Loan Repayment Program
Loan repayment assistance for medical and dental students who agree to provide services in eligible Health Professional Shortage Areas of greatest need.
Geographic coverage: Nationwide and U.S. Territories
Application Deadline: Oct 31, 2019
Sponsors: Health Resources and Services Administration, National Health Service Corps, U.S. Department of Health and Human Services

Technical Assistance for Small, Rural, Vulnerable Hospitals
Targeted technical assistance for rural hospitals to improve quality of care, maintain access to care, and address the challenges that are unique to small hospitals and the towns they serve.
Geographic coverage: Nationwide
Application Deadline: Oct 31, 2019
Sponsors: Center for Optimizing Rural Health, Texas A&M University Rural and Community Health Institute

Combating Opioid Overdose though Community-level Intervention
Grants for evidence-based, community-level programs that aim to reduce opioid-involved overdose. Projects must evaluate these community-based efforts to assess their efficacy in reducing opioid-involved overdose and other harms of opioid use, particularly in the regions of the United States with the highest rates of fatal and non-fatal opioid-involved overdoses.
Geographic coverage: Nationwide and U.S. territories
Application Deadline: Nov 1, 2019
Sponsor: University of Baltimore Center for Drug Policy and Enforcement

Eugene Washington PCORI Engagement Award: Community Convening Around Patient-Centered Outcomes Research
Funding for organizations and communities to hold convenings that include patients, researchers, clinicians, purchasers, payers, health system leaders, and other stakeholders. Convenings should focus on supporting collaboration around patient-centered outcomes research and clinical comparative effectiveness research. Rural is one of the suggested central themes for convenings.
Geographic coverage: Nationwide
Application Deadline: Nov 15, 2019
Sponsor: Patient-Centered Outcomes Research Institute

Service Area Competition Funding for Health Center Program (Areas Served with a Project Period Start Date of June 1, 2020)
Funding to provide comprehensive primary healthcare services to an underserved area or population. Areas with a June 1, 2020 project period start date are eligible to apply.
Geographic coverage: Nationwide
Application Deadline: Dec 2, 2019
Sponsors: Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services

Water and Waste Disposal Grants to Alleviate Health Risks on Tribal Lands and Colonias
Grants for water and waste disposal facilities and services on federally-recognized tribal lands, colonias, and rural areas that face significant health risks due to a lack of access to adequate, affordable water or waste disposal.
Geographic coverage: Nationwide
Applications accepted on an ongoing basis
Sponsors: U.S. Department of Agriculture, USDA Rural Development

New Resources

CAH Participation in Flex Financial and Operational Improvement Activities, 2015–2018
Examines patterns of Critical Access Hospital (CAH) participation in activities funded by the Medicare Rural Hospital Flexibility (Flex) Program. Looks at CAHs' participation in financial and operational improvement activities, with information by various hospital characteristics including risk of financial distress.
Sponsoring organization: Flex Monitoring Team
Date: 10/2019

Child Poverty Declines Slightly in 2018 to 18 Percent
Brief summary of child poverty rates. Includes a line chart showing the percent of children in poverty from 2007 through 2018 for city, suburban, and rural places.
Sponsoring organization: Carsey School of Public Policy
Date: 09/2019

Financial Alignment Initiative South Carolina Healthy Connections Prime: First Evaluation Report
Evaluation of the first year of the South Carolina Healthy Connections Prime demonstration to integrate care for the state's Medicare-Medicaid beneficiaries. Discusses access and other challenges for rural enrollees and how the program has worked to address rural needs.
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
Date: 09/2019

Impact of Rurality on Diabetes Screening in the US
Examines diabetes screening in urban, suburban, and rural areas, using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 through 2017.
Author(s): Phoebe Tran, Lam Tran, Liem Tran
Location: BMC Public Health,19, 1190
Date: 09/2019

Improving Oral Health in Rural Colorado: Commitment to Quality through Data-Informed Dental Care
Highlights a health center serving rural Colorado that decreased children's cavity rates through a program that featured increased caries risk assessments to understand patient risk factors for decay and increased placement of sealants.
Sponsoring organization: Bureau of Primary Health Care
Date: 09/2019

Indian Health Service: Facilities Reported Expanding Services Following Increases in Health Insurance Coverage and Collections
Report details rates of health insurance coverage in patients seen at Indian Health Service facilities. Looks at the rates of coverage by third party insurers, such as Medicare, Medicaid, and private plans, from 2013-2018.
Additional links: Full Report
Sponsoring organization: Government Accountability Office
Date: 09/2019

Mayo Clinic Joins the National Effort to Train Tomorrow's Rural Surgeons
Describes challenges facing rural surgery, including workforce shortages, outlines the Mayo Clinic's development of a rural general surgery track, and identifies lessons learned in the first three years of the Mayo Clinic's program. Compares competencies required for rural surgeons and those in urban areas.
Author(s): Randy C. Lehman, Brandon G. Douglass, Stephanie F. Heller, Michael C. Roskos
Location: Bulletin of the American College of Surgeons, 104(10)
Date: 10/2019

The New Economy and Child Care: Nonstandard-Hour Work, Child Care, and Child Health and Well-Being
Examines child care instability experienced by mothers with young children. Includes information from state child care administrators related to the support provided by the child care subsidy system for parents working nonstandard hours. Includes a brief discussion of rural child care deserts.
Sponsoring organizations: American Public Human Services Association, Mathematica
Date: 05/2019

A New Portrait of Rural America
Examines nine different types of rural counties: the African American South, aging farmlands, evangelical hubs, graying America, Hispanic centers, LDS enclaves, Native American lands, rural middle America, and working class country. Reports on factors impacting rural communities overall and by county type, including health insurance coverage and health status as well as demographic and socioeconomic factors. Includes county-level data for all counties and features on individual counties for each county type.
Additional links: Interactive: Explore Rural America's Diversity, Report, Resources: Community Type Maps and Data
Sponsoring organization: American Communities Project
Date: 09/2019

The Older Population in Rural America: 2012-2016
Describes the rural older population, those 65 years and older, compared to urban older adults. Includes rural-urban data on population size for the nation, by region, and by state. Also covers demographic, social, and economic characteristics, age distribution, and sex ratio by age. Some data is available by level of rurality for mostly urban, mostly rural, and completely rural counties.
Sponsoring organization: U.S. Census Bureau
Date: 09/2019

Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns
Analyzes trends in U.S. drug overdose mortality by key social determinants. Reports findings from a selective review of the literature on how the opioid crisis is impacting different segments of the population, including rural residents.
Additional links: PDF, Supplemental Material
Author(s): Gopal K. Singh, Isaac E. Kim, Mehrete Girmay, et al.
Location: International Journal of Maternal and Child Health and AIDS, 8(2), 89-100
Date: 2019

Promising Practice: Educational Partnership Reaches Rural California Communities
Details a promising practice that works to expand health literacy among rural Latinos in California through a partnership between the California State Office of Rural Health and the California Department of Public Health's Office of Binational Border Health. Details the way the program is reaching rural Latinos through community health worker/promotores training.
Sponsoring organization: National Organization of State Offices of Rural Health
Date: 08/2019

Russell County Hospital Listens to their Community to Improve Transitions of Care
Highlights quality improvement activities underway at a 25-bed Critical Access Hospital (CAH) in rural Kentucky. Discusses community collaboration efforts, expansion of specialty services, renovations, a focus on staff satisfaction, and care coordination activities.
Sponsoring organization: National Rural Health Resource Center
Date: 09/2019

Shaping Summertime Experiences: Opportunities to Promote Healthy Development and Well-Being for Children and Youth
Examines the impact of summertime experiences on school-age children and youth related to academic learning, social and emotional development, physical and mental health, and health-promoting and safety behaviors. Includes discussion of rural residence and its impact on children's access to supportive services, including food programs, during the summer.
Additional links: Read Online
Sponsoring organization: National Academies of Sciences, Engineering, and Medicine
Date: 2019

State Profile Map Series
Series of state profile maps showing disability rates at the county level, using data from the December 2018 American Community Survey. Maps for each state are planned to be added as they are completed and become available.
Sponsoring organization: Research and Training Center on Disability in Rural Communities

Study of Food Safety Needs of Adult Day Care Centers in the Child and Adult Care Food Program
Identifies the food safety education needs of adult day care centers. Examines food safety knowledge gaps, preferences for receiving food safety education, and methods for communicating about food safety education resources. Includes information on rural, town, and urban adult day care centers.
Sponsoring organization: USDA Food and Nutrition Service
Date: 09/2019

Subcommittee on Health Hearing: MISSION Critical: Care in the Community Update
Presents a U.S. House of Representatives Committee on Veterans' Affairs Subcommittee on Health hearing on the MISSION Act community care program. Focuses specifically on the program's coverage and consistency of care for veterans.
Additional links: Witness Statements
Sponsoring organization: House Veterans' Affairs Committee, Subcommittee on Health
Date: 09/2019

Use of Apprenticeship to Meet Demand for Medical Assistants in the U.S.
Reports findings from a study of registered medical assistant (MA) apprenticeship programs in 12 states. Discusses the workforce needs these programs may help address, including workforce needs in rural communities. Describes the programs and discusses challenges with starting and maintaining MA apprenticeship programs.
Additional links: Policy Brief
Sponsoring organization: UW Center for Health Workforce Studies
Date: 09/2019

Open Calls for Contributions

Call for Abstracts: 2019 5th Annual Penn State Addiction Symposium
Deadline: Oct 14, 2019
Pennsylvania Office of Rural Health
Event Dates: Dec 10, 2019
Hershey, PA
Conference Website

Call for Abstracts: 2020 Annual Oklahoma Rural Health Conference
Deadline: Oct 31, 2019
Rural Health Association of Oklahoma
Event Dates: May 4 - 5, 2020
Norman, OK
Conference Website

Call for Abstracts: 2020 8th Annual California Telehealth Resource Center Telehealth Summit
Deadline: Nov 1, 2019
California Telehealth Resource Center
Event Dates: May 12 - 14, 2020
Olympic Valley, CA
Conference Website

Call for Health Policy Resolutions and Position Papers: 2020 37th Annual Alaska Health Summit
Deadline: Nov 4, 2019
Alaska Public Health Association
Event Dates: Jan 21 - 23, 2020
Anchorage, AK
Conference Website

Upcoming Events

Rural Health Open Door Forum
Time: 2:00 - 3:00 p.m. Eastern
Centers for Medicare and Medicaid Services
2019 NARHC Fall Institute
National Association of Rural Health Clinics
St. Louis, MO
866.306.1961 Ext. 2
North Dakota Palliative Care TeleECHO: POLST & Serious Illness Conversations
Time: 12:00 - 1:00 p.m. Central
University of North Dakota Center for Rural Health, University of North Dakota School of Medicine & Health Sciences
Public Health and Transportation Webinar Series Part One: Collaborating Together for Community Health
Time: 2:00 p.m. Eastern
National Center for Mobility Management
Western Kentucky Regional Education Day - Addiction & Substance Abuse: Communities at a Crossroad
Kentucky Rural Health Association
Grand Rivers, KY
Under Attack: Year of the Breach
Time: 12:00 - 1:00 p.m. Central
Mississippi Rural Health Association
Dementia Care Updates Across Montana
Time: 12:00 - 1:00 p.m. Mountain
Billings Clinic, Montana Rural Health Initiative
All Things Missouri: Broadband Discussion
Missouri Rural Health Association
Columbia, MO
Recovery and Medication Assisted Treatment
Time: 1:00 p.m. Eastern
Psychiatry & Behavioral Health Learning Network
Oral Health Infrastructure Series: Teledentistry
Time: 12:00 - 1:00 p.m. Central
National Network for Oral Health Access
Screening for Food Insecurity
Time: 12:00 - 1:00 p.m. Central
Health Resources and Services Administration
2019 Michigan Critical Access Hospital Conference
Michigan Center for Rural Health
Traverse City, MI
2019 10th Annual Substance Use Prevention Conference
ACT Missouri
Lake Ozark, MO
2019 Rural Health Clinic Workshop: Complete/Improve Your Annual Program Evaluation
Mississippi Rural Health Association
Jackson, MS
The Providers Documentary: National Rural Health Day Viewing
Florida Rural Health Association
High Springs, FL
Rural Health Clinical Congress
Time: 8:00 a.m. Central
National Organization of State Offices of Rural Health, Rural Medical Education (RME) Collaborative
800.913.9370 Ext. 705
2019 Annual Texas EMS Conference
Texas Department of State Health Services
Fort Worth, TX

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