Robin Hood To Rescue Of Rural Hospitals? New Math Promised On Medicare Payments

As rural hospital closures roil the country, some states are banking on a Trump administration proposal to change the way hospital payments are calculated to rescue them.

The goal of the proposal, unveiled by Centers for Medicare & Medicaid Services Administrator Seema Verma last month, is to bump up Medicare’s reimbursements to rural hospitals, some of which receive the lowest rates in the nation.

For example, Alabama’s hospitals — most of which are rural — stand to gain an additional $ 43 million from Medicare next year if the federal agency makes this adjustment.

“We’re hopeful,” said Danne Howard, executive vice president and chief policy officer of the Alabama Hospital Association. “It’s as much about the rural hospitals as rural communities being able to survive.”

The proposed tweak, as wonky as it is, comes with considerable controversy.

By law, any proposed changes in the calculation of Medicare payments must be budget-neutral; in other words, the federal government can’t spend more money than previously allocated. That would mean any change would have a Robin Hood-like effect: increasing payments to some hospitals and decreasing them to others.

“There is a real political tension,” said Mark Holmes, director of the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. Changing the factors in Medicare’s calculations that help hospitals in rural communities generally would mean that urban hospitals get less money.

The federal proposal targets a long-standing and contentious regulation known in Washington simply as the “wage index.” The index, created in the 1980s as a way to ensure federal Medicare reimbursements were equitable for hospitals nationwide, attempts to adjust for local market prices, said Allen Dobson, president of the consulting firm Dobson, DaVanzo & Associates.

That means under the current index a rural community hospital could receive a Medicare payment of about $ 4,000 to treat someone with pneumonia compared with an urban hospital receiving nearly $ 6,000 for the same case, according to CMS.

“The idea was to give urban a bit more and rural areas a bit less because their labor costs are a bit less,” said Dobson, who was the research director for Medicare in the 1980s when the index was created. “There’s probably no exact true way to do it. I think everybody agrees if you are in a high-wage area you ought to get paid more for your higher wages.”

For decades, hospitals have questioned the fairness of that adjustment.

Rural hospitals nationwide have a median wage index that is consistently lower than that of urban hospitals, according to a recent brief by the Sheps Center. The gap is most acute in the South, where 14 of the 20 states account for the lowest median wage indices.

Last year, the Department of Health and Human Services Office of Inspector General found that the index may not accurately reflect local labor prices and, therefore, Medicare payments to some hospitals “may not be appropriately” adjusted for local labor prices. More plainly, in some cases, the payments are too low.

In an emailed statement to KHN, Verma said the current wage index system “has partly contributed to disparities in reimbursement across the country.”

CMS’ current proposal would increase Medicare payments to the mostly rural hospitals in the lowest 25th percentile and decrease the payments to those in the highest 75th percentile. The agency is also proposing a 5% cap on any hospital’s decrease in the final wage index in 2020 compared with 2019. This would effectively limit the loss in payments some would experience.

Dobson, a former Medicare research director, said he expects “enormous resistance.” (The CMS proposal is open for public comment until June 24.)

HHS Secretary Alex Azar, foreshadowing how difficult a change could be, said during a May 10 Senate budget hearing that the wage index is “one of the more vexing issues in Medicare.” It’s problematic, agreed Tom Nickels, an AHA executive vice president, noting in an emailed statement that there are other ways “to provide needed relief to low-wage areas without penalizing high-wage areas.”

It’s this split that appears to be dictating the range of reactions.

The Massachusetts Health & Hospital Association’s Michael Sroczynski, who oversees its government lobbying, questioned in an emailed statement whether the wage index is the correct mechanism for providing relief to struggling hospitals. The state’s hospitals have historically been at the higher end of the wage index.

In contrast, Tennessee Hospital Association CEO Craig Becker applauded the proposed change and said the Trump administration is recognizing the “longstanding unfairness” of the index. Tennessee has been among the hardest hit with hospital closures, counting 10 since 2012.

In Alabama, where four rural hospitals have closed since 2012, Howard said that without the change she “could see a dozen or more of our hospitals not being able to survive the next year.” Indeed, Howard said, hospitals in more than 20 states could gain Medicare dollars if the proposal passes and “only a small number actually get hurt.”

Kaiser Health News asked the Missouri Hospital Association, in a state where most hospitals do not stand to gain or lose significantly from the rule change, to calculate the exact differences in hospital payments under the current wage index formula. Under the complex formula, a hospital in Santa Cruz, Calif., an area at the top end of the range, received a Medicare payment rate of $ 10,951.30 — or 70% more — for treating a concussion with major complications in 2010, compared with a rural Alabama hospital, at the bottom end, which received $ 6,441.76 to provide the same care.

Even more, MHA’s data analysis showed that the lower payments to Alabama hospitals have compounded over time. In 2019, Medicare increased its pay to the hospitals in the Santa Cruz-Watsonville area for the same concussion care. It now stands at $ 13,503.37 — a nearly 23% increase above the 2010 payment. In contrast, rural Alabama hospitals recorded a 3% payment increase,  to $ 6,646.80, for the same care.

For Alabama, addressing the calculation disparity could be “the lifeline that we’ve been praying for,” Howard said.

Kaiser Health News

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Listen: Syphilis Spreads Into Rural America



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Lauren Weber, one of Kaiser Health News’ new Midwest correspondents, joined St. Louis Public Radio reporter Jeremy Goodwin on “St. Louis on the Air” Friday to discuss how syphilis is making inroads into rural counties across the Midwest and West. In Missouri, the total number of syphilis patients has more than quadrupled since 2012, testing the weakened public health safety net in areas unfamiliar with the potentially deadly infection. Listen to the interview on the St. Louis Public Radio website.

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Off the beaten path – best travel destinations in rural Europe

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Travel broadens the mind and enriches life experience, and this is the reason it is so important to try to do as much of it as you possibly can. There are so many wonderful travel destinations these days, and the rise of budget travel has allowed more people to see much more of the world.

The most fulfilling travel experiences are those that take you off the beaten track and onto the road less traveled. Who knows what mysteries wait just around the corner, and where you can discover them? If you want an unforgettable break this year, away from the frenzied, tourist-filled streets, here are some amazing European gems just itching to be discovered.

Alentejo region, Portugal

If you’re planning on heading for a vacay soon, one of the best places to check out is Portugal’s stunning Alentejo region. This delightful part of southern Portugal comes alive in the springtime, presenting a smorgasbord of incredible floral colors. With pinks, oranges, yellows, and whites blanketing the ground, there are serene and elegant walking routes around Alqueva Lake and across beautiful countryside. Oh, and there are some amazing restaurants en route in the city of Evora as well.

Pyrenees, French-Spanish border

The Pyrenees Mountains are spread across France, Spain, and Andorra, and you can take an incredible road trip that allows you to travel across borders and see some of the most amazing parts of the Pyrenees. Hire a car and take a remarkable three-day road trip that scales mountain peaks, gorgeous valleys, and picture-postcard villages. Enjoy the 3,000m views from the top of the Pic du Midi mountain, accessible by cable car.

Sardinia, Italy

Sardinia is a must-visit destination in Italy, and it’s one you might not think is that unique. Well, how about experiencing this amazing island as part of a sea kayaking adventure?! This offers an invigorating and unforgettable break, where you can hit hidden beaches, secret coves, and enjoy the gorgeous surroundings of Porto Conte. Starting in April, these trips give you the perfect Sardinian experience, and something unique that lets you have the spring break you’ve always wanted.

Carpathian Mountains, Romania

The Carpathian Mountains demand discovery, and this is one of the places you need to check out for your spring break. There are so many amazing reasons to take a trip here, but one of the biggest is bison tracking! Yes, believe it or not, you don’t have to go on an African safari to get your bison fix. High up in the foothills of the Carpathians, a conservation project has allowed these majestic creatures to thrive. You can stay in Bucharest, and head out in groups (fronted by rangers) into the wilds of the Tarcu Mountains to see bison, bears, and other creatures.

How about these for some off the track destinations to explore the beautiful and majestic underbelly of Europe. These are some incredible choices that can take you away from the crowds, and allow you to experience things you might not otherwise have been able to. Indulge, slip away, and lose yourself in the elegance of European delight.

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‘Virtual focus groups’ uncover clues to rural and urban HPV vaccination disparities

Researchers have harnessed the power of social media to understand differences in attitudes and behaviors about human papillomavirus (HPV) vaccination among hundreds of thousands of parents living in rural and urban areas.
Child Development News — ScienceDaily

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Huawei connects rural America. Could it threaten the country’s most sensitive military sites?

Outside Malmstrom Air Force Base in central Montana, spread across 13,800 square miles of open plains, more than 100 intercontinental ballistic missiles stand at the ready, buried deep underground in missile silos. These Minuteman III rockets are capable of delivering nuclear warheads at least 6,000 miles away and are part of the U.S. Strategic Command, which oversees the country’s nuclear and missile arsenal.


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A.I. Could Widen Economic Disparity Between Urban and Rural Areas, Brookings Report Warns

Among the key factors driving the economic divide in America is the rise of technology that has eliminated many jobs through automating manufacturing tasks. A new report from the Brookings Institution warns that, thanks to the rise of artificial intelligence, economic disparity between coastal cities and heartland regions is about to get even worse.

The 2016 Presidential election served as a wake-up call to the economic effect that the automation of many routine jobs is “massively rearranging the nation’s economic geography,” says the report, written by Brookings Senior Fellow Mark Muro.

“The 2016 election may go down as the first time society began to grasp the full implications of automation’s potential to transform the physical world,” Muro wrote. “As big, techy cities like New York, Washington, and the Bay Area seemed to increasingly inhabit a different world from the rest of America, the people and places that were ‘left behind’ revolted.”

Since then, the field of A.I. has made gains in developing machine-learning tools that could automate even more jobs. Brookings looked at the kinds of jobs that could be replaced by A.I. applications, namely, ones that involve more routine or repetitive work in manufacturing and service industries alike. The bottom line of jobs at risk of automation: They already pay some of the lowest wages today.

Jobs that were more vulnerable to automation were more likely to be found in rural towns like Kokomo, Ind., and Hickory, N.C., the report said, while those in coastal cities like San Jose and the District of Columbia were more likely to be safe.

“Less-educated heartland states and counties specialized in manufacturing and low-end service industries could be especially hard-hit by automation in the A.I. era, whereas well-educated states and counties along the Boston-Washington corridor and on the West Coast appear less exposed,” the report said. “In parallel fashion, smaller, less-educated communities will struggle relatively more with A.I.-phase automation, while larger, better-educated cities will experience less disruption.”

In response, Brookings urged government and industry leaders to focus on strategies such as expanding support for communities to cope with job automation and “future-proofing” workers by teaching skills that are more resilient to automation.

The report comes a few days after the Trump administration unveiled a vague A.I. initiative that will spend on artificial intelligence and train workers in computer science. Apple CEO Tim Cook and IBM CEO Ginni Rometty have joined Trump’s advisory board on A.I. and job automation.

Fortune

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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10 of the best rural breaks in the UK

The UK countryside comes alive in spring and these breaks – everything from seal-spotting to cycling and even wine-tasting – make the most of it

The North York Moors come alive in spring, with heather creating a sweet-scented carpet of colour for walkers – and there are plenty of pubs and tearooms for refuelling. Join a three-night walking break with HF Holidays for guided moor and coast hikes from a base at Larpool Hall, Whitby. This year is also the 50th anniversary of the 109-mile Cleveland Way, celebrated with WalkFest, a programme of guided walks and children’s treasure hunts from 24-27 May
Book it From £289 for three nights’ full board, hfholidays.co.uk

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Travel | The Guardian

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5 villages you should visit in rural England

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Ahhhhh, England. With its big and bustling cities, its red double-decker buses, its glorious West End, and the incredible Royal Family and palaces, it can often be easy to forget that England offers some of the best countrysides in the world. Although it may just be a small island, England offers quaint little villages surrounded by fields, rural hamlets inside rolling valleys and so much more. So what are you waiting for? Check out these 5 villages you should visit in rural England and book your plane tickets now!

Castle Combe, Cotswolds

When it comes to rural areas in England, the Cotswolds take the (tea and) biscuits. In the Wiltshire, Cotswolds lies Castle Combe, a beautiful and historic little village that looks as if it has been stuck in time. Because of its rustic charm and its riverside location, you might recognize Castle Combe from numerous films, such as Steven Spielberg’s War Horse, and the 2007 movie, Stardust. With its cobbled stone cottages, rugged streets, small doorways, glorious shrubbery and medieval churches and ruins, it really is a thing of beauty.

Polperro

If you want to see traditional and rural England, a trip to Cornwall is a must. With their laid-back lifestyles and their reluctance to enter the technological world (in some villages you can only pay with cash!), the Cornish towns and villages epitomize the English countryside and seaside. One of the most beautiful villages in this area is Polperro, a traditional and authentic seaside village on the East coast of the country. The winding streets of Polperro are paved with cobblestones, and nearly all of them lead you down to the idyllic harbor and its small fishing boats. With direct links to the English Channel, the village was once used as a smuggling village, for vagabonds and their contraband to travel over to Guernsey. There’s no shortage of trinkets and hand-crafted gifts in this village, and their fresh seafood is second to none!

Hawkshead

Hawkshead is located in the incredible Lake District and full to the brim with history, amazing views, gorgeous countryside and of course – a heck load of lakes! The village itself is a traditional 15th-century village, with quaint whitewashed thatched cottages, medieval ruins and buildings, and beautiful windy streets. The village itself is steeped in English history and features William Wordsworth old grammar school, and a special Beatrix Potter Gallery which explores her work and her love for the Lake District. The village is also perfect for those whole love country walks – and with Lake Windermere and Lake Coniston surrounding the village, there isn’t a lack of space.

Staithes

According to one travel writer, Staithes in North Yorkshire is England’s greatest hidden gem – and it’s not hard to see why. As the home of the avid explorer, Captain Cook, Staithes is steeped in history. Although it is small, its idyllic fishing point is an attraction point for people all across the country, who flock to see the tall and thin fishing houses, the river running through the village, the fishing cove and the beautiful hills surrounding it. And of course, like any fishing village, the pubs and seafood are top of the range.

Abbotsbury

Located just 10 miles away from the seaside of Weymouth and the Jurassic Coast, Abbotsbury is a quintessentially British country village. Steeped in history, Abbotsbury is a Victorian gem in the heart of rural Dorset that is full to the brim with rolling fields, glorious parks, woodland valleys, and impressive gardens filled with rare and beautiful flowers. The village is also famous for its paintings, artwork and wood carvings, so you won’t be able to leave without taking a bit of Abbotsbury with you!

Looking to take a trip to Blighty? England is well known for its idyllic countryside, so if you’re vacationing there then you need to check out these rural villages. Picturesque doesn’t even cut it!

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