The Northern Border Region: A Health-Focused Landscape Analysis

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern Border Region. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission. For more information, please contact Katherine Ahrens, Ph

Exploring State Data Sources to Monitor Rural Emergency Medical Services Performance Improvement

In 1981, responsibility for overseeing emergency medical services (EMS) largely shifted to states and localities, contributing to the creation of a fragmented national picture of the state of EMS that is most evident in the resultant data collection and reporting issues that curb the availability of EMS data. These patchwork systems of care disproportionately affect rural areas, where myriad challenges – from a high reliance on a volunteer workforce to low call volumes and inadequate reimbursement – hinder performance. Previous studies by the Flex Monitoring Team (FMT) highlighted how little is known about the administrative, operational, and clinical capacity of rural EMS, which are key to investigate further before considering traditional EMS outcome measures. In this study, the FMT convened an expert panel comprised of representatives from a variety of stakeholders to highlight existing data challenges EMS face, identify data to support rural EMS performance measurement, as well as reassess the FMT’s 2017 rural-relevant EMS performance measures. Among the themes raised by the panel, experts suggested that improved engagement in oversight by state EMS agencies would increase accountability by local EMS; however, they cited a lack of staff capacity and expertise to analyze data in states, as well as disagreement between states on relevant measures. The FMT created EMS capacity measures to monitor and improve rural EMS capacity, along with the National Highway Traffic Safety Administration’s EMS Compass outcome measures to monitor performance. Potential opportunities identified by the panel to source standardized data for those measures include an assessment tool developed through the Joint Committee of Rural Emergency Care, or for the relevant data to be collected by state EMS agencies through their existing EMS service licensure process, many of which already collect some of the relevant data. Electronic patient care records, the typical source of data to calculate EMS clinical and non-clinical performance measures, can be collected and reported to states through the National EMS Information System (NEMSIS). Though not perfect, targeted efforts to improve the collection of local EMS data provides an opportunity for state EMS agencies and State Flex Programs (SFPs) to train local services in data collection, in addition to educating them on how to access and use their own data for performance improvement. This collaboration can also play a role in supporting improved health information exchange between EMS, hospitals, and other providers, which help improve the quality of pre-hospital care and assist in monitoring the quality and outcomes of care across the system of care. The importance of reliable, standardized, and timely data from local and state EMS is underscored by the recently launched Medicare Ground Ambulance Data Collection System, a Centers for Medicare and Medicaid Services study that will collect information to evaluate how ground ambulance costs relate to current payment policies. In turn, this will be used to formulate a report to Congress assessing the adequacy of Medicare ground ambulance payment rates and geographic variations in cost. As the data will be used to assess reimbursement rates across urban, rural, and super rural areas, accurate data collection and reporting is vital. The expert panel also reaffirmed the validity of FMT’s rural-relevant measures and raised questions about monitoring the measures longitudinally or developing measures to assess financial performance and sustainability. Additional work is needed to understand how to best use these measures to track rural EMS capacity over time, as well as identify the relevant financial measures

Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services [Chartbook]

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of counties in each state with ambulance deserts, the number of ambulance stations per 100,000 residents, and the number and percent of people living in ambulance deserts. National level maps illustrating the number and percent of people living in ambulance deserts at the county level are presented overall, as well as by rural and urban counties. State level maps illustrating the location of ambulance stations, health care facilities, and ambulance deserts at the census block level are presented in Appendix A. Finally, the discussion and conclusions section summarizes the findings and sets the stage for future analyses of populations most at risk for adverse health outcomes associated with poor access to ambulance services. For more information, please contact Dr. Yvonne Jonk, [email protected]

Patterns of Health Care Use among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their: socioeconomic and health characteristics that may inform health care use; trends in health care use, including use of inpatient and emergency department (ED) care; outpatient and prescription services; specialists and dentists; and home health and durable medical equipment. Although the percentage of older adults (age 65+) remains higher in rural areas of the U.S., we found that adults over age 85 comprise a similar proportion of the Medicare population in rural and urban areas. Findings showed that rural and urban beneficiaries age 85+ had similar health (general health, chronic conditions) and functional outcomes (ADLs, and IADLs) across the study years and that the average number of visits to primary care providers for both rural and urban beneficiaries decreased over time. However, compared with urban beneficiaries, rural beneficiaries were significantly less likely to visit specialists, dentists, and receive outpatient services. Rural-urban differences in the percentage of beneficiaries who visited the Emergency Department were higher in all study years, with significant differences in 2011, 2012, and 2017. FMI: Yvonne Jonk, PhD, Deputy Director, Maine Rural Health Research Center

Vermont: A Health-Focused Landscape Analysis

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern Border Region. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission. For more information, please contact Katherine Ahrens, Ph

New Hampshire: A Health-Focused Landscape Analysis

The Northern Border Regional Commission State and Region Chartbooks compile county- and state-level data related to health and health care access for the Northern Border Region and the individual states of Maine, New Hampshire, New York, and Vermont. Topics covered in the chartbooks include demographic and socioeconomic characteristics, access to care, health outcomes, mortality rates, Health Professional Shortage Areas, and the location of Rural Health Clinics, Federally Qualified Health Centers, hospitals, and substance use treatment facilities. When data allow, we highlight the counties with the worse performance on a measure, compared with the rest of the counties in the Northern Border Region. These data are intended to inform initiatives to support health and health care, particularly in rural counties and counties served by the Northern Border Regional Commission. For more information, please contact Katherine Ahrens, Ph

Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook

This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues using data from CMS’s Provider of Services file, Medicare Cost Reports, and the Robert Wood Johnson Foundation’s’ County Health Ranking and will be useful to policymakers and others interested in the performance of RHCs nationally. It can also be useful to RHC administrators to benchmark staffing patterns, productivity, and efficiency. Finally, it provides a discussion of the challenges related to collection and reporting of RHC quality data. For more information, please contact John Gale, [email protected]

The Health Care Costs of Financial Exploitation in Maine

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse. Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs

How Did We Get Here? Rural Health Challenges in America [Podcast]

In this podcast, Drs. Ziller and Jonk of the Maine Rural Health Research Center discuss the modern issues and challenges in rural health care and the historical factors that have influenced the basis of our current rural health system. They touch upon rural access to elder care, dental care, health insurance and more. Dr. Ziller is the Chair and Assistant Professor of Public Health at the University of Southern Maine’s Muskie School of Public Service where she teaches courses on health policy and the U.S. healthcare system. She is also the Director of the Maine Rural Health Research Center, and has directed numerous studies on rural health access, coverage and health reform. Dr. Ziller has served on the editorial board of the Journal of Rural Health, and has won national awards for her contributions to this field. Dr. Jonk is an Associate Research Professor of Public Health at the University of Southern Maine’s Muskie School of Public Service, and is the Deputy Director of the Maine Rural Health Research Center. As a health economist, she specializes in rural health, access to health care and health insurance coverage