Health reform said to hurt rural doctor recruitment

Recruiting doctors to rural hospitals will get harder in the next few years as the Patient Protection and Affordable Care Act reaches full implementation and the demand for healthcare services increases, a new report suggests. An Association of Staff Physician Recruiters report, "In-House Physician Recruitment Benchmarking," says interview-to-hire ratios in rural areas are much higher than in urban, and rural recruiting officers are often responsible for several things, not just hiring new doctors, making them overworked. Both factors make it harder for rural hospitals to recruit, the authors concluded. (University of Chicago photo)

ASPR Benchmarking Committee Chair Shelly Tudor told John Commins of HealthLeaders Media that the cost of recruitment is rising, making it hard for rural hospitals to compete with their urban counterparts. "In lots of respects, the process favors urban providers. Physicians are coming to urban areas and they are looking for jobs, whereas rural providers have to go out and target physicians that are likely to come to their area," Tudor said. Rural recruiters have to "filter through a lot of people to find the right one who is willing to come in and even look at the opportunity," she said. (Read more)

Physicians for Social Responsibility say 'each step of the coal life cycle impacts human health'

A new report released this week analyzes the human health impacts of coal, with a specific focus on the cumulative impacts of air pollution from burning coal on the respiratory, cardiovascular and nervous systems. The Physicians for Social Responsibility study, "Coal's Assault on Human Health," concluded that "each step of the coal life cycle -- mining, transportation, washing, combustion and disposing of post-combustion waste -- impacts human health."

Researchers found that mining of coal contributes to heart disease, cancer, stroke and chronic respiratory diseases, four of the five leading causes of death in the U.S. In particular, burning coal contributes to diseases affecting large portions of the U.S., including asthma, lung cancer, heart disease and stroke. It also impairs lung development, increases heart-attack risk and hinders intellectual development. The report adds to previous correlation studies suggesting possible links between mountaintop mining and increased rates of disease in Appalachia by University of West Virginia public-health professor Michael Hendryx.

Physicians for Social Responsibility makes several recommendations, including reducing carbon dioxide emissions "as deeply and as swiftly as possible," ending construction of new coal-fired power plants, reduction of fossil fuel use and the development of renewable energy sources. (Read more)

Feds want 1,000 rural hospitals to switch to electronic health records by 2014

The federal government wants 1,000 "critical access" and rural hospitals to adopt electronic health records by 2014, and is funneling about $30 million through its Regional Extension Center to make it happen. The money could help as many as 1,500 rural hospitals, or 90 percent of those covered by the Small Rural Hospital Improvement Program.

The Office of the National Coordinator for Health Information Technology has already secured $32 million in American Recovery and Reinvestment Act money for REC for IT improvement at critical access hospitals, which are classified as facilities with no more than 25 beds and an average of 10 patients a day, Neil Versel of Information Week reports.

The National Rural Health Association is enthusiastic about the funding, but still sees obstacles to implementation, Versel reports. "To realize this goal, we need all hands on deck. We need everyone rowing in sync, including leadership and staff in every critical access and rural hospital, electronic health records vendors, hospital associations and state offices of rural health in every state, Rural Health IT Network Development grantees, Office of the National Coordinator grantees, and many more public and private, federal and local partners," ONC Office of Provider Adoption Support director Mat Kendall, and ONC rural health IT coordinator at Leila Samy said. (Read more)

Access and cultural issues make alcohol, prescription pills rural drugs of choice

"Alcohol and non-heroin opiates are the drugs of choice in rural populations ... while heroin and cocaine top the list in urban areas, according to a new report from the Substance Abuse and Mental Health Services Administration," reports Aaron Levin of Psychiatric News. Methamphetamine usage was about the same in rural and urban areas, "despite the common assumption that meth is largely a rural problem," Levin writes. Rural people also use slightly more marijuana.

Higher use of alcohol and non-heroin opiates, or prescription painkillers, in rural areas may reflect access issues, SAMHSA's Center for Substance Abuse Treatment director H. Wesley Clark said. "Illegal drugs may be harder to conceal in the pipeline to rural areas, or legal substances may be less stigmatized." Rural people steal about 67 percent of the prescription pills they abuse from friends or family. The rest come from doctors, University of New Mexico psychiatry professor Snehal Bhatt told Levin.

About 67 percent of rural users started using before 18, compared to 53 percent of urban users. This probably leads to higher rates of rural youth binge drinking and driving drunk, according to a University of Southern Maine study. "Rural youth, their families and peers are less likely to disapprove of youth drinking than urban youth, risk factors that are associated with greater likelihood of adolescent alcohol use," researcher John Gale wrote in the study. (Read more)

Rural people more likely to die from colon cancer

Rural people with colon cancer are more likely to be diagnosed late and receive inferior treatment than their urban counterparts, according to a new University of Minnesota study. Rural colon cancer sufferers are also more likely to die from the disease. This is the first study of its kind to show that outcomes in colon cancer are affected by where a person lives, Tiffany Chao reports for ABC News.

The study focussed on more than 100,000 patients diagnosed with colon cancer from 1996 to 2008, with rural people making up 15 percent of the total. Rural patients were 4 percent more likely to get a late diagnosis, had 17 percent lower odds of receiving chemotherapy and had an 18 percent lower chance of getting lymph nodes removed during cancer-removal surgery, indicating that their treatment was most likely inadequate. Overall, rural patients were 5 percent more likely to die from colon cancer. (Read more)

Rural areas have higher percentage of uninsured

The share of rural people under 65 without health insurance increased 8 percent during the recession, and is now higher than in cities or suburbs, according to U.S. Census Bureau data. Before 2005, rates of uninsured were about the same in rural and urban areas, but during the recession, the rate of uninsured rural people rose to 18.4 percent, compared to 17.7 percent in urban areas, Bill Bishop of the Daily Yonder reports.

The data show "a huge variation in the percentage of uninsured by state," Bishop writes. In 16 states, at least one in five rural residents under 65 didn't have health insurance. From highest to lowest, they were: Texas, Alaska, Florida, Nevada, New Mexico, Oklahoma, Georgia, Idaho, Colorado, Mississippi, Montana, South Carolina, Arkansas, Oregon, Louisiana and North Carolina. The rate of rural people without insurance was higher than in urban areas in all but six states: Illinois, California, Nevada, Connecticut, Florida and New York. (Read more)

Lesser-educated white people, especially women, are living shorter lives, study finds

The life expectancy of white people without a high school diploma fell from 1990 to 2008, with women losing the most, an average of five years, according to a new University of Illinois at Chicago study. These demographics (older and less educated) are disproportionately rural.

The average life expectancy for white women without a high-school diploma was 73.5 years, compared to 83.9 for those with a four-year college degree or more. White men who did not fionish high school are living an average of 67.5 years, compared to 80.4 for those with a four-year degree or more.

"The reasons for the decline remain unclear, but researchers offered possible explanations, including a spike in prescription-drug overdoses among young whites, higher rates of smoking among less-educated white women, rising obesity, and a steady increase in the number of the least-educated Americans who lack health insurance," reports Sabrina Tavernise of The New York Times.

"Some cautioned that the results could be overstated because Americans without a high school diploma — about 12 percent of the population, down from about 22 percent in 1990, according to the Census Bureau — were a shrinking group that was now more likely to be disadvantaged in ways besides education, compared with past generations," Tavernise reports.

The study was published last month in the journal Health Affairs, and the National Academy of Sciences is investigating the decline to better determine its cause. (Read more)

Study: Rural people more likely to get Alzheimer's

Rural residents are twice as likely to get Alzheimer's, according to a University of Edinburgh study that collected "all over the world and spanned several decades," Nikki Tucker of Medical Daily reports. Researchers say limited access to health care, exposure to unknown substances, and socioeconomic factors may lead to the increased risk.

Prior studies have analyzed the difference in what effects rural and urban areas might have on the disease, but because of debate about what constitutes "rural" and "urban," results have been deemed inconclusive. (Read more) The study was published in the International Journal of Epidemiology.

Federal grants will improve telehealth services for rural veterans in Virginia, Montana and Alaska

A disproportionate number of veterans are in rural areas, and telehealth could soon improve their health care, which is often lacking because of limited resources or long-distance travel to Department ofVeterans Affairs  hospitals. The Department of Health and Human Services has partnered with the VA to provide almost $1 million to rural veterans' health care providers to improve VA telehealth and HHS state health information exchanges. The three states with the highest rates of rural veterans -- Virginia, Montana and Alaska -- will each receive about $300,000.

The VA said its telehealth system, once it's fully integrated nationwide, will be capable of providing at least 1.2 million medial consultations annually for veterans who would otherwise have to travel long distances to be treated, Robert Longley of About.com reports. Under the Honoring America's Veterans Act signed by President Obama last month, the VA is authorized to waive co-payments for veterans who use telehealth services. (Read more)

Western N.C. county hopes its prescription-drug task force will address high rate of overdoses

One hundred people die every day from drug overdoses, according to the Centers for Disease Control, and almost three out of four of those are due to prescription drugs, according to the National Institutes of Health. Prescription drug abuse is an epidemic that began in Appalachia, and as one western North Carolina county deals with the issue,  a local newspaper is putting it on the public agenda.

Wikipedia map

Yancey County (Wikipedia map) has "one of the worst rates" of unintentional overdoses of prescription drugs in the U.S., said Yancey Mitchell Prescription Drug Abuse Task Force chair Mechelle Akers. The task force presented information to the Yancey County Commission this week, reports Jonathan Austin of the Yancey County News. In 2008 to 2010, the county had 13 overdose deaths. Akers, who is a pharmacist, said the numbers exceed North Carolina and Yancey's neighboring counties' overall rates.

Seventy percent of those who overdose from prescription drugs get them from family members or friends, Akers said. The "flood of painkillers has swamped law enforcement," Austin reports. There were 102 drug arrests in 2002, and 800 last year. Angel Light Counseling addiction specialist John Williams told Austin: "Addiction to drugs is the largest problem our society faces, and legally prescribed medication constitute a large percentage of this problem. With the economy the way it is, people are more depressed and worried. They seek some kind of relief. They turn to something that alters their consciousness to reduce their worry." (Read more)

Obama orders VA to focus on mental health, with special emphasis on rural areas

President Obama signed an executive order Friday directing the Department of Veterans Affairs to expand mental health services and suicide prevention efforts, with a special emphasis on rural areas, which provide a disproportionate share of military members, Megan McCloskey of Stars and Stripes reports. Much of the order contains initiatives that were announced earlier in the summer by the VA.

The order instructs that any veteran with suicidal thoughts be seen by a mental-health professional within 24 hours, a standard already set by the VA but rarely met, McCloskey reports. In many areas of the U.S., psychologists, psychiatrists and social workers are sparse. To address this, the order directs the VA to partner with the Department of Health and Human Services to utilize community services to help meet demand. The agency will also create 15 pilot sites in underserved areas by contracting with local facilities, and it must create a plan for rural areas, which could include a mental health professional sharing program, McCloskey reports.

The VA put together a 21-person team in June to begin addressing these issues, and it has until June 2013 to hire just under 2,000 additional mental health staffers and the issues with pay, loan repayment, scholarships and partnerships with community-based providers to lure more mental health employees. (Read more)

Volunteer emergency medical services becoming less prevalent as they run short of volunteers

Volunteer EMTs in Maddock, N.D.

Volunteer emergency medical service squads appear to be dying out as rural populations change and EMS evolves. Volunteer squads have long been the sole emergency responders in many rural areas, reports Candi Helseth of the health-oriented Rural Assistance Center, but according to a 2010 study, "Rural Volunteer EMS: Reports from the Field," 69 percent of 49 local EMS directors in 23 states reported problems recruiting and retaining volunteers.

The North Carolina Rural Health Research and Policy Analysis Center study reported three main reasons for loss of EMS volunteers: high numbers of retirees or elderly in rural areas are unlikely to have physical strength required for EMS, many working-age individuals leave rural areas to find jobs elsewhere, and volunteers have too many obligations to cover weekends. Voluinteer fire departments have reported similar problems.

Almost three-quarters of the all-volunteer EMS agencies hosted fundraising events to get necessary funding, requiring further time commitments. At least one-half of these agencies have started some type of paid compensation, but it's still less than maintaining a full-time staff. Twenty percent of EMS leaders reported being "uncertain of their ability to maintain future service," and 8 percent were "frankly pessimistic" about the future. (Read more)

Tobacco use highest in rural areas; factors include companies' targeting of youth, Lung Assn. says

Tobacco use is higher among rural communities than in suburban and urban areas, and smokeless tobacco use is twice as common. According to the American Lung Association, rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction, death and disease.

In its latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” ALA says the increased tobacco use is associated with lower education levels and lower incomes, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.

The exposure to secondhand smoke is also likely to be higher, since rural communities are less likely to have smoke-free air laws in place, and that probably makes residents less likely to ask individuals not to smoke in their homes or other indoor places they control.

The report also pointed out that the tobacco industry "spends millions of dollars targeting rural youth," and "these young people are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco-cessation programs and services to get the help they need to quit. Promotion of the availability of state counseling services by phone and online resources also lags in rural communities."

To read the full report, go here.

Male life expectancy falls in some rural areas; Central Appalachian coalfield stands out

The life expectancy of the average American man increased by 2.1 years from 1999 to 2009, but only 15 percent of all rural and exurban counties matched that increase, and in 158 of them, male longevity declined, according to data compiled by the Institute for Health Metrics and Evaluation at the University of Washington.

Counties where men's lifespan is growing shorter in rural America are clustered in Appalachia, the deep South and Southern Oklahoma, report Bill Bishop of the Daily Yonder and Roberto Gallardo of Center for Rural Affairs. The data suggest that rural men are "simply not keeping up with the health advances in the rest of the country," they write. Of the 50 rural or exurban counties with the largest declines in male longevity, 29 were in coal-producing counties in Kentucky, Tennessee, Virginia or West Virginia. Six were in Oklahoma and four were in Georgia. (Yonder map; click on image for larger version)

Bishop and Gallardo write that men were already living shorter lives in these counties than the national average before 1999; but over the last decade, men's short lives grew shorter. States with the ten counties where men's longevity shortened the most are Tennessee, Kentucky, West Virginia and Mississippi. Five of those counties are in Kentucky and three are in West Virginia. The states with the 10 counties where men's lives grew longer are Washington, Arizona, Texas, Utah, Pennsylvania, Alabama and Minnesota. (Read more)

South Dakota starts program to get health workers, not just doctors, to work in rural areas

Mindy Jagerson, left and Julie Crick at
work at the Freeman Regional Health
Services Hospital (Argus-Leader photo)

Incentives to get doctors in rural areas, like this one in Missouri, are common. Now a program will put $10,000 bonuses into the hands of newly hired health-care employees if they promise to keep working in rural South Dakota for three years. The money comes from the state with a matching share from the worker's employer, reports Jon Walker of the Argus Leader in Sioux Falls. The South Dakota legislature approved the arrangement this year to protect towns where hospitals and nursing homes struggle to find employees.

The jobs include nurses, dietitians, nutritionists, lab technicians, pharmacists, paramedics, X-ray technologists and occupational, physical and respiratory therapists. "It's a no-brainer for the staff person," said Dan Gran, CEO at Freeman Regional Health Services. "They get their $10,000. All they've got to do is show up and maintain their employment. We benefit because we've retained them."  The program is limited to communities with less than 10,000 people.  If the town is smaller than 2,500, the state will pay 75 percent.

The new program bypasses federal involvement, notes Walker. It would use about $300,000 a year from the state general fund. A companion program sets up bonuses for rural health professionals with more training. They range from $35,000 for midlevel professionals to $100,000 for doctors starting new jobs and promising to stay three years in towns smaller than 10,000. The state again covers up to 75 percent of costs. Annual cost is $515,000 for the state. Deputy State Health Secretary Tom Martinec said it's reasonable to use public money to assist private business. "The fact of the matter is we need health care workers in rural areas. They're competing against larger towns. That's why we needed to step in."
 

Rural hospitals urge Congress to save two Medicare programs that help them

A coalition of rural hospitals are lobbying Congress to keep two Medicare programs that the National Rural Health Association says are vital to keep hundreds of smaller hospitals going. The Medicare Dependent Hospital designation and the Low-Volume Hospital Adjuster, which date to the 1980s, help keep low-volume rural hospitals' doors open with the Medicare payment adjustments they provide, according to the NRHA.

Both programs could end Oct. 1 without Congressional action. "Rural facilities do not have the financial background to weather all of these cuts," said Lance Keilers, NRHA president and administrator of Ballinger Memorial Hospital in San Angelo, Tex., told Brendon Nafziger of DOTmed News, an online magazine serving the medical and medical equipment industry.

More than 200 hospitals have the Medicare Dependent designation. To qualify, a hospital must have fewer than 100 beds and Medicare patients must make up 60 percent of its inpatient days or discharges. Low-volume hospitals must be at least 15 miles from another hospital and provide care for fewer than 1,600 Medicare beneficiaries a year. (Read more)

Report: Women in four of five rural counties live shorter lives

Rural women live shorter lives than urban women, according to a data analysis by the Daily Yonder and the Nebraska-based Center for Rural Affairs. In four out of five rural and exurban counties, women have shorter lives, report the Yonder's Bill Bishop and CRA's Roberto Gallardo. (Yonder map; click on it for larger version)

The average age of death for women was 81.3 years in 2009, the most recent year with available data. Out of 2,500 rural and exurban counties, women in only 540 of those reached the national average age of death, Bishop and Gallardo report. Women in the upper Midwest live "considerably longer lives" than those in the Southeast. The pair report that this pattern is similar for rural men. (Read more)

Time to check your local hospital's credit rating

What is your local hospital's credit rating? Did you even know it had a credit rating? It might be a good time to check it, since many hospitals are getting lower ratings these days.

Nick Tabor, senior staff writer for the Kentucky New Era in Hopkinsville, found that Jennie Stuart Medical Center's rating dropped, meaning that "The hospital may have to pay a higher interest rate if it needs to borrow money in the near future." Tabor wrote.

Fitch Ratings, one of the global agencies whose ratings guide investors, said uncertainty about the expansion of Kentucky's Medicaid system and how federal health reform will affect the hospital's finances were other reasons for the downgrade. The hospital has lost money in two of the last four years. Last year, it had a 1.9 percent loss.

Tabor explains there are eight ratings above the BBB level. If the facility's rating "were to slip two levels lower, to BB+, it would be on the level of 'junk bonds,' no longer considered investment grade," he reports.

There are three major rating companies in the U.S.: Fitch, Moody's and Standard and Poor's. Moody's expects downgrades of nonprofit hospitals to outnumber upgrades by the end of 2012, reports Jeffrey Young for The Huffington Post. Fitch expects the same will happen, said Senior Director Emily Wong. Smaller hospitals will especially feel the pinch since they "don't have as much ability to offset expense, inflation or reimbursement reductions," Wong said.

AA- and A-rated facilities are reviewed every two years. BBB and BBs are reviewed once a year, and B- and below-rated facilities are reviewed every six months. The easiest way to check ratings for hospitals is to get an account at each of the three major rating companies. "These accounts are free and easy to set up," Tabor tells us. (Read more)

Federal agency finds elevated levels of problematic substances in air, soil and water near strip mines

After a year of testing air, water and soil around mountaintop removal mine sites in Central Appalachia, the U.S. Geological Survey has found high levels of toxins in the soil and water, concluding that people in southern West Virginia living close to these sites are living in an environment "with significant chemical discrepancies from the rest of the state," reports Alice Su of The Center for Public Integrity. The findings are the first conclusive scientific evidence by a federal agency that mountaintop removal mining could cause human health risks.

USGS research geochemist Bill Orem, the principal investigator, said water in mining areas had unusually high acid and electrical conductivity levels in the water, air had abnormal levels of particulates, and soil and streams had irregular levels of polycyclic aromatic hydrocarbons. "Several PAH compounds are probable or possible human carcinogens," Su notes. Orem said results are preliminary and research is still being conducted, but soil samples from mining areas were "certainly different" from those in non-mining areas, and that airborne silica particles, known to cause lung disease, were "definitely higher."

Orem said the USGS will be "prudent" to connect preliminary data to actual health problems in the region that have been documented in controversial correlation studies by West Virginia University public health professor Michael Hendryx. "You have to be conservative in your statements," Orem said. "It can't be driven by people's feelings. It has to be a scientific, data-driven process." (Read more)

New book focuses on Appalachian health

A new book, which compiles health reviews and studies from the 13-state Appalachian region, reveals greater health care disparities between counties within the region than between Appalachia and the rest of the U.S.

Kevin Kavanagh reviewed Appalachian Health and Well-Being for The Courier-Journal, and reports that the rural Central Appalachia region is "extensively discussed" in the book as having some of the nation's highest rates of poverty, tobacco and drug use, obesity and diabetes.

"The vast majority of the chapters are a well-written, comprehensive discussion of the problems affecting Appalachia," Kavanagh writes. "An important concept is that unhealthy lifestyles are not just the patient's fault, but also a social problem; making substantial headway requires improvement in poverty, education and employment."

The book, edited by Robert Ludke and Phillip Obermiller of the University of Cincinnati, is available from the University Press of Kentucky.