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Alan Morgan Chief Executive Officer National Rural Health Association National Rural Health Association: Rural Health Care Access- A National Policy Perspective

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Page 1: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Alan MorganChief Executive OfficerNational Rural Health Association

National Rural Health Association Rural Health Care Access- A National Policy Perspective

NRHA Mission

The National Rural Health Association is a national

membership organization with more than 21000

members whose mission is to provide leadership on

rural issues through advocacy communications

education and research

The State of Rural America

bull Workforce Shortages

bull Vulnerable Populations

bull Chronic Poverty

THE IMPORTANCE OF TODAY

Rural healthcare is critical for rural patients and the rural economy

bull You canrsquot have a healthy rural economy without a healthy rural community

bull Quality rural healthcare saves lives provides skilled jobs attracts businesses and reinvests millions back into rural communities

MetroNon Metro Life Expectancy

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 2: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

NRHA Mission

The National Rural Health Association is a national

membership organization with more than 21000

members whose mission is to provide leadership on

rural issues through advocacy communications

education and research

The State of Rural America

bull Workforce Shortages

bull Vulnerable Populations

bull Chronic Poverty

THE IMPORTANCE OF TODAY

Rural healthcare is critical for rural patients and the rural economy

bull You canrsquot have a healthy rural economy without a healthy rural community

bull Quality rural healthcare saves lives provides skilled jobs attracts businesses and reinvests millions back into rural communities

MetroNon Metro Life Expectancy

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 3: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

The State of Rural America

bull Workforce Shortages

bull Vulnerable Populations

bull Chronic Poverty

THE IMPORTANCE OF TODAY

Rural healthcare is critical for rural patients and the rural economy

bull You canrsquot have a healthy rural economy without a healthy rural community

bull Quality rural healthcare saves lives provides skilled jobs attracts businesses and reinvests millions back into rural communities

MetroNon Metro Life Expectancy

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 4: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

THE IMPORTANCE OF TODAY

Rural healthcare is critical for rural patients and the rural economy

bull You canrsquot have a healthy rural economy without a healthy rural community

bull Quality rural healthcare saves lives provides skilled jobs attracts businesses and reinvests millions back into rural communities

MetroNon Metro Life Expectancy

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 5: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

MetroNon Metro Life Expectancy

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 6: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Chart1

Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females
709
704
0
0
717
712
731
727
738
736
745
744
748
747
751
75
758
755
76
755
768
759
772
762
778
763
788
768
791
771

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
1969-1971 1969-1971 1969-1971 1969-1971 0 0
1972-1974 1972-1974 1972-1974 1972-1974
1975-1977 1975-1977 1975-1977 1975-1977
1978-1980 1978-1980 1978-1980 1978-1980
1981-1983 1981-1983 1981-1983 1981-1983
1984-1986 1984-1986 1984-1986 1984-1986
1987-1989 1987-1989 1987-1989 1987-1989
1990-1992 1990-1992 1990-1992 1990-1992
1993-1995 1993-1995 1993-1995 1993-1995
1996-1998 1996-1998 1996-1998 1996-1998
1999-2001 1999-2001 1999-2001 1999-2001
2002-2004 2002-2004 2002-2004 2002-2004
2005-2009 2005-2009 2005-2009 2005-2009
2007-2011 2007-2011 2007-2011 2007-2011
Page 7: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

A

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Table 2 Life expectancy at birth (in years) in metropolitan and non-metropolitan areas of the United States 1969-2011
Figure 2 Trends in Life Expectancy at Birth (Years) in Metropolitan and Non-Metropolitan Areas of the
United States 1969-2011
Urban Rural
Year
1969-1971 709 704
1972-1974 717 712
1975-1977 731 727
1978-1980 738 736
1981-1983 745 744
1984-1986 748 747
1987-1989 751 750
1990-1992 758 755
1993-1995 760 755
1996-1998 768 759
1999-2001 772 762
2002-2004 778 763
2005-2009 788 768
2007-2011 791 771
Figure 3 Metropolitan and Non-Metropolitan Differences in Life Expectancy (Years) United States 1969-2011
Table 2 Metro and Non-Metro Difference in Life Expectancy at Birth United States 1969-2011
Year Both sexes Males
1969-1971 05 07
1972-1974 05 07
1975-1977 04 07
1978-1980 02 05
1981-1983 01 04
1984-1986 01 02
1987-1989 01 02
1990-1992 03 05
1993-1995 05 05
1996-1998 09 11
1999-2001 10 12
2002-2004 15 16
2005-2009 20 21
2007-2011 20 20
Page 8: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

A

Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Male Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
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0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Page 9: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
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0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 10: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
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0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 11: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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Page 12: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 13: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 14: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 15: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
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0 0 0 0 0
0 0 0 0 0
Page 16: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 17: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 18: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 19: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
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0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 20: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0 0
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0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 21: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
Page 22: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
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0 0 0
0 0 0 0 0
Page 23: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
Page 24: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 25: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 26: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 27: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 28: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 29: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 30: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 31: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 32: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
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0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 33: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 34: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 35: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 36: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 37: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 0 0 0 0
Page 38: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Female Life Expectancy by Age and Area DeprivationUnited States 1980-2000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
Page 39: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 40: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 41: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 42: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 43: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 44: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 45: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 46: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 47: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 48: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 49: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 50: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 51: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0
Page 52: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
0 0 0 0 0
Page 53: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0
Page 54: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 55: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 56: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 57: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 58: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Women Aged 65+ Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 59: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Heart Disease Mortality Among US Men Aged 65+ Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 60: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 61: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 62: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 63: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 64: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Men Aged 25-64 Years by Area Socioeconomic Status (II)1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 65: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Cardiovascular Disease (CVD) Mortality Among US White Women Aged 25-64 Years by Area Socioeconomic Status (II) 1969-1998
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 66: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 67: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Women
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 68: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
Men
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0 0
Page 69: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist Quintile (Low SES)
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile (High SES)
Age-Adjusted Death Rate per 100000 Population1970 US Population Used as Standard
White Men
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0 0
Page 70: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Ist SES Decile (Most Deprived) 1980-1982
1st SES Decile (Most Deprived) 1998-2000
10th SES Decile (Least Deprived) 1980-1982
10th SES Decile (Least Deprived) 1998-2000
Life expectancy (years)
Life Expectancy by Age and Socioeconomic DeprivationUnited States 1980-2000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0
Page 71: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Page 72: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
Total US Population
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
Page 73: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Men
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
Page 74: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Age
Difference in life expectancy (years)
US Women
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
Page 75: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
ampA
Page ampP
difference 1980-1982
difference 1989-1991
difference 1998-2000
e(0) 1980-82
e(0) 1989-91
e(0) 1998-2000
Socioeconomic Deprivation Group
Difference in e(0) between decile 10 and every other deprivation group
Life expectancy (years)
Inequalities in Life Expectancy at Birth e(0) by Soocioeconomic Deprivation United States 1980-2000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Page 76: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
1980-1982
1989-1991
1998-2000
Difference 1980-82
Difference 1989-91
Difference 1998-2000
Life expectancy (years)
Life Expectancy at Birth by Socioeconomic Deprivation United States 1980-2000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
0 0 0 0 0 0
Page 77: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
White 1980-1982
Black 1980-1982
White 2000-2004
Black 2000-2004
Life expectancy at birth (years)
Male Life Expectancy by Race and Socioeconomic Deprivation Quintiles United States 1980-2007
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
0 0 0 0
Page 78: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Both Sexes
Males
Females
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
0
Page 79: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000
Metro Both Sexes
Non-Metro Both Sexes
Metro Males
Non-Metro Males
Metro Females
Non-Metro Females

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
0 0 0 0
Page 80: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Declining Rural Life Expectancy

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 81: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

National Rural Health Association Membership

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 82: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Where are the uninsured today

Source NYT ldquoThe Impact of Obamacare Oct 312016

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 83: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Obesity

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 84: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

More likely to report fair to poor health Rural counties 195 Urban counties 156

More obesity Rural counties 274 VS urban counties 239 Less likely to engage in moderate to vigorous exercise rural

44 VS urban 454

More chronic disease (heart diabetes cancer) Diabetes in rural adults 96 VS urban adults 84

Rural Health Disparities

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 85: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Rural Mortality RatesA Rural Divide in American Death

Center for Disease Control January 2017 Study

ldquoThe death rate gap between urban and rural America is getting widerrdquo

bull Rates of the five leading causes of death mdash heart disease cancer unintentional injuries chronic respiratory disease and stroke mdash are higher among rural Americans

bull Mortality is tied to income and geography

bull Minorities especially Native Americans die consistently prematurely nation-wide but more pronounced in rural

bull Startling increase in mortality of white rural women Causesbull Risky lifestyle (smoking alcohol abuse opioid abuse obesity)bull Environmental cancer clustersbull Suicides

January 2017

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 86: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)

bull Reported death rates were higher in rural areas (180 deaths per 100000 persons) compared with urban areas (158 deaths per 100000 persons)

bull Analysis indicated that while overall cancer incidence rates were somewhat lower in rural areas than in urban areas incidence rates were higher in rural areas for several cancers those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers

bull While rural areas have lower incidence of cancer than urban areas they have higher cancer death rates The differences in death rates between rural and urban areas are increasing over time

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 87: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Behavioral Health ndash Suicide Rates

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 88: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Behavioral Health

65 of non-metro counties have no psychiatrists (80 of remote counties)

65 of non-metro counties have no psychologists (61 of remote counties)

Non-metro counties with these providers have about 50 fewer per 10000 population than metro counties

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 89: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Poverty in Rural America

PBS News March 2017

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 90: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Opioid fatality rates are highest in states with large rural populationsThe rate of opioid-related overdose deaths in nonmetro counties is 45 higher than in metro counties(Source Centers for Disease Control and Prevention)

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 91: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

The Rural Health Safety Net is Under Pressure

The Average Rural Hospital Payor Mix is 55 Governmental2

Rural Non-Rural

Closed Rural Hospitals1

Rural Hospitals with Negative Margin2

83 Rural Hospital Closures

Since 2010

44of rural hospitals

in the red in 2017

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 92: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Less Broadband Access(Source Wall Street Journal)

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 93: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

What NRHA is Fighting For1 Access to care2 A robust rural workforce3 Strong funding for the rural health safety net

What NRHA is Doingbull Messaging to the Hill and the Administration on the rural

challenges and opportunitiesbull Developing new delivery models of care and new payment

methodologiesbull Disseminating best practices

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 94: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Global Budgetingbull CMMI published White Paper on Global Budgeting and rural

providersbull Maryland All-Payer Model

bull Fixed global budgets based on historical cost trends

bull Pennsylvania initiated Global Budgeting demonstrationbull Approximately 8 rural hospitals participatingbull Hope to start January 1 2018bull Karen Murphy Secretary of Health in PA a former CMMI leaderbull Rural providers and SORH so far enthusiasticbull Featured at 2017 Rural Hospital Innovation Summit San Diego

bull Concernsbull Variations in cost due to seasons and epidemicsbull Services covered under budget and for what populationspayers

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 95: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Future Model Community Outpatient Modelbull 247 emergency Services

bull Flexibility to Meet the Needs of Your Community through Outpatient Carebull Meet Needs of Your Community through a Community Needs Assessmentbull Rural Health Clinicbull FFQHC look-a-likebull Swing bedsbull No preclusions to home health skilled nursing infusions services observation

care

bull TELEHEALTH SERVICES AS REASONABLE COSTSmdashFor purposes of this subsection with respect to qualified outpatient services costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costsrdquo

bull ldquoThe amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such servicesrdquo

bull $50 million in wrap-around population health grants

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 96: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Celebrate the greatness of rural health carebull Rural independence rural work ethic rural

ingenuity rural providers doing more with less

bull Fortitude even through the most challenging of times

Higher qualityHigher patient satisfactionCost-effectiveFewer Resources

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 97: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

US Census show that after a modest four-year decline the population in nonmetropolitan counties remained stable from 2014 to 2016 at about 46 million (2014-2016 rural adjacent to urban saw growth)

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 98: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Although some rural areas are indeed declining in population this figure obscures the larger overall trend The number of students in rural school districts is steadily growing according to data compiled by the National Center for Education Statistics (NCES)

The Rural Youth Population Is Growing

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 99: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Rural Programs to Improve Access to Carebull Safety Net Programs-maintaining the rural health

infrastructure

bull Rural Training Track Programs- ldquogrow your ownrdquo rural healthcare pipeline

bull Rural Community Health Worker Training Network over 750 CHWs trained to date including rural cancer prevention and intervention

bull Research-maintaining federal funding for continued rural health research

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29
Page 100: Rural Health Care Access- A National Policy Perspective › sites › telemedicine...The National Rural Health Association is a national membership organization with more than 21,000

Alan MorganChief Executive OfficerNational Rural Health Association

G o R u r a l

  • Slide Number 1
  • NRHA Mission
  • Slide Number 3
  • Slide Number 4
  • Slide Number 5
  • Slide Number 6
  • Slide Number 7
  • Slide Number 8
  • Slide Number 9
  • Slide Number 10
  • Rural Health Disparities
  • Slide Number 12
  • Rural Cancer Rates(Source Centers for Disease Control and Prevention MMWR Series July 2017)
  • Slide Number 14
  • Slide Number 15
  • Slide Number 16
  • Opioid fatality rates are highest in states with large rural populations
  • The Rural Health Safety Net is Under Pressure
  • Slide Number 19
  • Less Broadband Access(Source Wall Street Journal)
  • Slide Number 21
  • Slide Number 22
  • Slide Number 23
  • Slide Number 24
  • Celebrate the greatness of rural health care
  • Slide Number 26
  • Slide Number 27
  • Rural Programs to Improve Access to Care
  • Slide Number 29

National Rural Leadership Lenders’ Roundtable · National Rural Leadership Lenders’ Roundtable . Rural Community Infrastructure Roundtable Meeting . Denver, Colorado . Raymond

National Rural Livelihood Mission (NRLM) Rural... · 2018. 7. 16. · District Manual – National Rural Livelihood Mission (NRLM) 1 1. National Rural Livelihood Mission (NRLM) 1.1

Estonian National Rural Network

Production of 21,000 ethylene oxide

National Rural Health Association: An Introduction · 2016-11-09 · National Rural Health Association: An Introduction. NRHA Mission The National Rural Health Association is a national

NATIONAL RURAL HOUSING COALITION · National Rural Housing Coalition (NRHC) National Rural Water Association (NRWA) NeighborWorks America (NWA) Rebuilding Together Rural Coalition

AY 21,000 CPD - CityFeet

Scottish National Rural Network. Norman MacAskill Head of Rural Policy, SCVO Norette Ferns Scottish National Rural Network Website Editor

India: National Rural Livelihood Mission India: National Rural Livelihood Mission India: National Rural Livelihood Mission

Update National Rural Transit Assistance Program - …sp.scopt.transportation.org/Documents/2017/2017.06.14 National RTAP... · Update –National Rural Transit Assistance Program

(National) Lithuania - Rural Development Programme programa...Lithuania - Rural Development Programme (National) CCI 2014LT06RDNP001 Programme type Rural Development Programme Country

NATIONAL RURAL HOUSING COALITION

NATIONAL BANK FOR AGRICULTURE AND RURAL DEVELOPMENT … nabard.pdf · NATIONAL BANK FOR AGRICULTURE AND RURAL DEVELOPMENT ... National Bank for Agriculture and Rural Development,

Sweden - Rural Development Programme (National) Svezia.pdf · 1 Sweden - Rural Development Programme (National) CCI 2014SE06RDNP001 Programme type Rural Development Programme Country

National Institute of Rural Developmentnird.org.in/NIRD_Docs/newsletters/apr2013.pdf · National Institute of Rural Development ... World Bank, Ministry of Human ... Rural Development

Rural challenges, national opportunity · national opportunity. Shaping the future of rural Canada. CONTENTS. Introduction 2 FCM: The national voice of rural Canada 3 ... Federal-municipal

21,000 RSF - LoopNet

House - National Rural Housing Coalitionruralhousingcoalition.org/wp-content/uploads/2017/06/Rural... · NATIONAL RURAL HOUSING COALITION 1331 G Street, ... Northwest Regional Housing

Marocco - National Rural Roads Programme - Appraisal Report · NATIONAL RURAL ROADS PROGRAMME APPRAISAL REPORT ... ERR = economic rate of return ... NRRAI = National Rural Roads Accessibility

National Rural Health Mission

2015 Rural Health Summit National Organization of State Offices of Rural Health Rural Recruitment and Retention Network National Cooperative of Health

National Rural Health Day

A National Survey of Orthopedic Surgeons Regarding the ... Polling Company - A National... · Orthopedic Surgeons estimated there were over 21,000 board certified orthopedic surgeons

National Rural Health Commissioner

India’s National Rural Employment Guarantee …€™s National Rural Employment Guarantee Scheme: What Do We ... rollout of India's National Rural Employment Guarantee Scheme,

NRLM National Rural Livelihoods Mission · NRLM National Rural Livelihoods Mission NRLP National Rural Livelihood Project NSS National Sample Survey ORAF Operational Risk Assessment

National Institute of Rural Development & Panchayati Rajddugky.info/images/kb/Kaushal Bharat_Revised... · National Institute of Rural Development & Panchayati Raj Ministry of Rural

(National) Malta - Rural Development Programme › en › EU Funds Programmes... · 1 Malta - Rural Development Programme (National) CCI 2014MT06RDNP001 Programme type Rural Development

NATIONAL RURAL SUPPORT PROGRAM

Rural Health – A National Prospective Alan Morgan Chief Executive Officer National Rural Health Association

BYLAWS NATIONAL RURAL HEALTH ASSOCIATION · National Rural Health Association Bylaws 1 BYLAWS Of the NATIONAL RURAL HEALTH ASSOCIATION Revised May 2015 Mission To improve the health

National Frontier & Rural ATTC

PART I RURAL DEVELOPMENT STATISTICS II NATIONAL … · II NATIONAL AND INTERNATIONAL RURAL DEVELOPMENT POLICIES ... The stated national objectives for rural ... NATIONAL AND INTERNATIONAL

NATIONAL BANK FOR AGRICULTURE AND RURAL DEVELOPMENT … nabard.pdf · NATIONAL BANK FOR AGRICULTURE AND RURAL DEVELOPMENT ... National Bank for Agriculture and Rural Development

Top Floor 21,000 SF