Encouraging Rural Health Clinics to Provide Mental Health Services: What are the options?

Key Findings: Approximately 6% of independent and 2% of provider-based RHCs offer mental health services. 38% of study RHCs reported their mental health services were not profitable but continued to provide them in response to community and patient needs. An important factor in the development of RHC mental health services is the presence of a local champion who spearheads the development effort

The Provision of Mental Health Services by Rural Health Clinics

The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings: Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health services is the presence of an internal champion (typically clinicians or senior administrators) who identify the need for and undertake implementation of services, help overcome internal barriers, and direct resources to the development of services

Rural Families More Likely to be Uninsured and Have Different Sources of Coverage

This study used the 2001/2002 Medical Expenditure Panel Survey (MEPS), conducted by the Agency for Healthcare Research and Quality (AHRQ), to examine the patterns of insurance coverage within rural families and to assess differences in family-level insurance status for rural and urban families (including comparisons between rural families living adjacent to and not adjacent to an urban area). Among partially uninsured families, we examined rural-urban differences in the sources of family coverage for insured family members (Medicare, Medicaid/ SCHIP, private, or a combination)

Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program

Since the first full year of Flex Program funding, the number and range of EMS improvement activities proposed by participating facilities has increased substantially. This report describes the EMS-related projects that states proposed to conduct in fiscal year 2004-2005

The Community Benefit and Impact of CAHs: the Results of the 2007 CAH Survey (Policy Brief #6)

In 2007, the Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators covering a wide variety of questions concerning hospitals’ community benefit and impact activities. The survey found that nearly all CAHs offer financial assistance to patients in the form of charity care and discounted charged, while nearly half had conducted a formal community needs assessment in the past three years and two-thirds have planning processes to address new service or other community needs. Results from the survey also showed that more than 75% of CAHs have relationships with other CAHs and non-CAH organizations, EMS, schools, and public health agencies, in addition to supporting many of them

Consolidated imaging: Implementing a regional health information exchange system for radiology in Southern Maine

The traditional, film-based radiology system presents serious limitations for patient care. These include forcing clinicians to make decisions based on information that is often less than optimal and making transfers of films and prior studies to other facilities more complicated than they need to be. Picture Archiving and Communication Systems (PACS) address these issues by allowing for acquisition, storage, display, and communication (e.g., transportation) of images in a digital format. Although PACS has been shown to improve patient care, many rural health care organizations have found obtaining these systems cost-prohibitive. The Consolidating Imaging Initiative (CI-PACS) in Maine provides an alternative way to offer this technology to rural hospitals. Through CI-PACS, a tertiary care hospital and its health care system have implemented a shared, standards-based, interoperable PACS in two rural hospitals (one belonging to the larger health system and one not). In this article, we discuss how the regional system works, and how it will be sustained. We also highlight the unique challenges associated with implementing a regional system.https://digitalcommons.usm.maine.edu/facbooks/1192/thumbnail.jp

Uninsured Rural Families

ABSTRACT: Context:Although research shows higher uninsured rates among rural versus urban individuals, prior studies are limited because they do not examine coverage across entire rural families. Purpose: This study uses the Medical Expenditure Panel Survey (MEPS) to compare rural and urban insurance coverage within families, to inform the design of coverage expansions that build on the current rural health insurance system. Methods: We pooled the 2001 and 2002 MEPS Household Component survey, aggregated to the family level (excluding households with all members 65 and older). We examined (1) differences in urban, rural-adjacent, and rural nonadjacent family insurance coverage, and (2) the characteristics of rural families related to their patterns of coverage. Findings: One out of 3 rural families has at least 1 uninsured member, a rate higher than for urban families—particularly in nonadjacent counties. Yet, three fourths of uninsured rural families have an insured member. For 42% of rural nonadjacent families, this is someone with public coverage (Medicaid/SCHIP or Medicare); urban families are more likely to have private health insurance or a private/public mix. Conclusions: Strategies to expand family coverage through employers may be less effective among rural nonadjacent than urban families. Instead, expansions of public coverage or tax credits enabling entire families to purchase an individual/self-employment plan would better ensure that rural nonadjacent families achieve full coverage. Subsidies or incentives would need to be generous enough to make coverage affordable for the 52% of uninsured rural nonadjacent families living below 200% of the federal poverty level

Characteristics of Inpatient Psychiatric Units in Small Rural Hospitals

Objectives: This study investigates inpatient psychiatric units (IPUs) in small rural hospitals todetermine their characteristics, the availability of community-based services post discharge, and the impact of the new Medicare payment system on these units. Methods: Telephone survey of IPU managers in all rural hospitals with less than 50 beds that had an IPU in 2006 (n=86). Seventy-three interviews completed for a response rate of 85%. Results: A typical small rural hospital IPU is a 10-bed geriatric unit with 200 admissions per year. They are paid primarily by Medicare (median of 84%), and are typically staffed with one each of psychiatrists, psychologists, social workers, counselor/therapists or nurse practitioners. Total staffing including nursing and unlicensed staff averages 18 FTEs. Common diagnoses were depression (74%), schizophrenia or other psychoses (57%) and dementia or Alzheimer’s (57%). IPU managers reported little difficulty obtaining post-discharge care (average 5% of patients). Most clinicians staffing IPUs also provide out-patient services locally (86% of psychiatrists and 81% of psychologists). Of 8 recently closed IPUs, 5 reported closing due, in part, to changes in Medicare reimbursement. Conclusions: Rural IPUs have good access to community-based services. We conclude that these communities have a better infrastructure of mental health services, due, in part, to the presence of the IPU, and the willingness of IPU clinicians to provide out-patient services locally. We also conclude that changes in Medicare reimbursement have contributed to closure of some of these units, and may, thereby, contribute to the erosion of the rural mental health infrastructure

The Community Benefit and Impact of CAHs: Results of the 2007 CAH Survey (Briefing Paper #19)

In 2007, the Flex Monitoring Team conducted a national telephone survey of 381 critical access hospital administrators covering a wide variety of questions concerning hospitals’ community benefit and impact activities. This Briefing Paper reports on the community benefit and impact findings of this survey. The results indicate that critical access hospitals are active in monitoring the health and health system needs of their communities, are engaged with other community rganizations and stakeholders to address those needs, and provide services (often free) for patients and other provider organizations in the community that enhance access to care and help build the local rural health system. Nearly all CAHs offer financial assistance to patients in the form of both charity care and discounted charges. In addition to free and discounted care provided to patients, CAHs are engaged in community needs assessments, gap-filling service development, and other activities that demonstrate their attention and responsiveness to community and rural health system needs

A Review of State Flex Program Plans 2004-2005 (Briefing Paper #10)

The Balanced Budget Act of 1997 established the Medicare Rural Hospital Flexibility Program (Flex Program) which consists of two separate but complementary components: a Medicare reimbursement component that provides approved cost-based reimbursement for certified Critical Access Hospitals (CAHs) and a state grant component administered by the Federal Office of Rural Health Policy (ORHP) to strengthen the rural healthcare infrastructure using CAHs as the hubs of organized systems of care. This briefing paper focuses on the state grant component of the Flex Program, examining the objectives and project activities proposed by states in their Flex Program grant applications for Fiscal Year 2004 and highlights recent trends in State Flex Program planning, development, and implementation. Both an executive summary document and the full report are available for download below