The Membership Organization of State Offices of Rural Health
Fifty-five counties in rural Missouri are now without a hospital. Death rates are higher for rural Missourians than urban in each of the top ten causes of death. These and other statistics are included in a new report that looks at the health status of rural Missourians.
Health in Rural Missouri: (Biennial Report 2018-2019) looks at demographic characteristics and other factors, as it has in prior reports. But this year the entire report was done through the lens of social determinants of health (SDOH), according to Kathryn Metzger, Programs Manager at the Missouri State Office of Rural Health (MO SORH), which issued the report.
“In prior years it was mostly done by the numbers—people pulled the numbers and interpreted them,” Metzger said. “This time, we wanted to identify those things most impacted by SDOH, and use that in discussing everything going forward.” The 2018-2019 report focuses on five of the most important SDOH impacting rural health: economic stability, neighborhoods and built environment, health and healthcare, social and community context, and education.
For example, Metzger said, in the section that discusses education, “We put education levels alongside diabetes rates so you can see that as educational attainment decreased, the diabetes rates increased,” she said. “That’s really important when you’re looking at programming—you start getting into health literacy issues. You want to make sure that people understand the medical advice they are getting, especially with diabetes, which is complex and difficult for everyone to understand.”
Another big change with this year’s report, beyond content, Metzger said, “and one that was important to best serve Missouri’s communities, was to make it easier to read.” In previous years’ reports, she said, “it was a very technical document, written in an academic style, that would have required a pretty high level of health literacy and an understanding of statistics.”
“We want to try to expand the audience,” she continued. “The goal was to use plain language so that the information will be accessible to anyone on the ground doing the work in the community. We also wanted to make sure that when we couldn’t use words that were plain language, we would include a glossary that links to them.” Terms that appear in the glossary are italicized in the report.
Another more visual change is that the new report features award-winning photos from the Missouri Department of Agriculture’s Focus on Missouri Agriculture Photo Contest. “We used photos of people in Missouri taken by people in Missouri,” Metzger said. Rural scenes, including a large photo of a smiling Missouri farmer on the Table of Contents, are used throughout its pages.
Although MO SORH is required by statute to issue the report every two years, Metzger said, “this is much more than we are required to do—it could be done in a five-page overview. But it gives us an opportunity to speak to our lawmakers about our needs and also to share information with our community. I think it keeps Missouri’s finger on the pulse of what is actually happening across the state.” This year’s report is 88 pages.
The report being issued biennially also points out significant changes in health status, Metzger said. “If you have a county that has had a really low rate of something but then, all of a sudden, in a two-year time span, you see it go to a high rate, it draws your focus,” she said.
Metzger said that in recent years the reports have been longer also because their data capacity as a state has changed. “We have a lot more access and we’re using state-specific data sources,” she said. The current report draws on MOPHIMS (Missouri Public Health Information Management System) and the Missouri County-Level Study, she said.
The report was partially funded through SORH funds, Metzger said, with the rest of the funding coming from other state budget sources.
In the coming weeks, Metzger said she hopes to pull together factsheets from the report as well as present webinars that will discuss how to use and interpret the data.“It’s my hope that this year’s report will be easy to understand by everyone at the grassroots level interested in furthering the health of their community—whether it’s a hospital, a non-profit, or a walking club,” Metzger concluded. “I hope that it is used for writing grants, for developing programming, and maybe identifying some opportunities to make an impact in ways people hadn’t previously thought.”
Appropriations Update:
On the week of October 28, the Senate began deliberation on a Labor-HHS appropriations bill for fiscal year (FY) 2020. Senate Majority Leader McConnell filed cloture on the motion to proceed to the House-passed Labor-HHS spending bill (H.R. 2740). However, on October 31, the vote to pass the House bill and begin floor debate failed in a 51-41 vote.
Congress has a November 21, 2019 deadline to enact funding for FY 2020. If a bill is not passed by then another continuing resolution will need to pass. Members indicated this week that a continuing resolution could extend into early spring of 2020.
NOSORH is working with Congress to ensure the State Offices of Rural Health line is funded at the House-passed level of $12,500,000 for FY ’20. The current Senate measure only includes $10,000,000 in funding.
Telehealth Package Introduced:
On October 30, a bipartisan group of lawmakers reintroduced the CONNECT for Health Act, a bill intended to expand payment for telehealth services. The comprehensive telehealth package would remove geographic restrictions on payment for various services, including for virtual mental health treatment.
The bill, S. 2741, would also allow patients to get coverage for treatment they receive at home. The bill would also encourage CMMI to test out a new telehealth payment model for Medicare and allow some restrictions on telehealth coverage to be waived during national and public health emergencies.
The bill was introduced by Senators Brian Schatz (D-HI) and John Thune (R-SD). A companion measure, H.R. 4932, was introduced on the House side by Rep. Mike Thompson (D-CA). While the telehealth package is unlikely to pass as a stand-alone package, a number of provisions from the bill could be advanced in other legislative vehicles. Last Congress a number of provisions included in the CONNECT Act made it into the 2018 Bipartisan Budget Act.
Trio of Rural Health Bills Introduced:
On October 29, three rural health-related bills were introduced in the House.
Companion bills were introduced in the Senate earlier this year by Senator Marsha Blackburn (R-TN). Earlier this summer, Senate Finance Committee Chairman Chuck Grassley (R-IA) indicated the committee may look to advance a more comprehensive rural health bill. Were that to occur, these bills could be in consideration.
The 2019 NOSORH Annual Meeting that will take place in Albuquerque, New Mexico, on October 16-17 at the DoubleTree by Hilton Albuquerque. The theme for this year’s meeting is “Plug in to the Power of Rural”. This theme will be the guiding force while planning the meeting. You can also note the theme in the 2019 Partnership Invitation. The planning committee will be convening soon and your input is always welcomed. If you have any thoughts or ideas, please email them to Matt Strycker. More information regarding the meeting will be provided via email and posted to the NOSORH website as it becomes available.
Discounted rooms are available to meeting participants at the rate of $94 single occupancy or $114 double occupancy per night plus taxes until September 24, 2019. Use the code “NOS” to reserve a room online or by phone, Click here or call 800-445-8667. We look forward to seeing you in Albuquerque! If you have questions, please contact Matt Strycker or Trevor Brown.
Last month, representatives from 12 primary care offices (PCOs) attended the PCO Training Academy and Mentoring Kickoff meeting. The meeting, planned by NOSORH and the Association of State and Territorial Health Officials (ASTHO), was held at the ASTHO offices in Crystal City, VA.
The training academy brings together six selected mentors and six mentees as they undertake a formal mentoring experience. The kickoff meeting is the initial step in the mentoring experience where mentees are provided an orientation to the role of a PCO from the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce. In addition, mentees learn about the PCO National Committee, traditional primary care access points, the evolution of primary care, and engage in a number of peer-led discussions leveraging the expertise of the mentors.
This year’s mentees come from the states of AR, DE, GA, ID, MS and VT. Experienced PCO staff from the states of CO, NE, NH, NY, TN and VA have been gracious with assisting their peers through mentoring. The PCO mentoring program is supported by NOSORH as a subcontract under ASTHO’s NOSLO Cooperative Agreement with HRSA. In addition to supporting the mentoring program, NOSORH also provides logistical support to the PCO National Committee and assists with the development of ASTHO resources for primary care and rural health issues.
The National Rural EMS & Care Conference, hosted by the South Carolina Office of Rural Health and the South Carolina Office of EMS, was a resounding success in Charleston! The conference brought together EMS providers, state EMS directors, State Offices of Rural Health and so many more. It is no small feat to pull off a successful national conference, and it wouldn’t have happened without a dedicated conference planning committee, a passion for the work, and the coordination of a small army of people. NOSORH, the JCREC, and the planning committee would like to thank all the volunteers, the host state, and all the people that made this year’s conference one of the best yet.
Kevin McGinnis, NASEMSO, reviews the draft Tactical Plan for Rural EMS with conference participants.
One of the attendees noted, “This meeting has benefited the state trauma program because it brings together not only EMS, trauma professionals, but also the rural health partners. The relationship between the partners is occasionally overlooked and this venue not only increases awareness, but helps to establish a foundation. This annual meeting may also help to educate and secure the relationships between ORH and EMS/Trauma/other time critical emergencies as the health department leadership can easily make the connection between the various rural health programs and their impacts on each other. Rural healthcare is often overlooked and this meeting increases awareness of the rural patient’s health disparities.”
Another said, “This was a great meeting for networking and discussion. The format and variety of sessions was great, and the speakers were all phenomenal – true leaders in rural EMS and excellent at providing quality education to attendees.”
For all the presentations from the conference, including information on a Tactical Plan for the Future of EMS, please click here. Also, be on the lookout for 2020 conference plans!
State Offices are invited to register for the brand-new Learning to Lead: The Jim Bernstein SORH Leadership Institute! This 12-part, online Institute provides rural-focused professional development for State Office of Rural Health (SORH) staff in current and future leadership positions. Registration is filling up quickly, so be sure to register by Friday, May 10, to reserve your spot!
Check out the Leadership Institute Flyer and Leadership Institute webpage for additional information, including session descriptions, registration information, and pricing.
Don’t miss this unique development opportunity to enhance your ability to provide influential leadership and management within your State Office (and earn a Rural Health Leadership certificate)! Please contact Tammy Norville for more information.
You’re invited to “Plug in” to the Power of Rural by partnering and sponsoring with NOSORH! Whether you’re a long-time friend and supporter of NOSORH and National Rural Health Day, or considering partnering for the very first time, there are plenty of new and exciting ways to connect! The 2019 NOSORH Partnership Invitation outlines various levels of support, including a new opportunity to plan a customized concept as an Exclusive Partner in the NOSORH mission.
As you’ll see, NOSORH is exploring new approaches to building robust collaborative partnerships to improve the future of rural health. This is a chance to be a part of something bigger than an exhibit table or a “regular” sponsorship opportunity. Each level of support offers ways to connect you with new possibilities and increase your reach and visibility on the rural stage. In addition to recognition at the NOSORH Annual Meeting, you will become a valued partner in National Rural Health Day on November 21 and gain recognition through the activities developed to promote the #PowerofRural campaign.
“Plug in” to partnership with NOSORH and our mission as an investment in the health of rural America, the Power of Rural campaign and an opportunity to shine the light on the important work of rural health care! NOSORH greatly appreciates the support from partners over the years through various contributions. No matter what level of sponsorship you select, know that you will make a difference!
Please contact Ashley Muninger, ashleym@nosorh.org with any questions.
Often the best ideas on community healthcare come from community members themselves—especially when they are engaging in active discussions with healthcare providers and others.
That’s the idea behind community cafes, sponsored by the Alaska State Office of Rural Health (AK-SORH), which are being held in small towns in the state.
“Last spring we told all our Critical Access Hospitals (CAHs) that we can come to their communities to facilitate a conversation on whatever topics they want,” said Heidi Hedberg, AK-SORH Director.
The community cafes are set up to last an hour, with the first 25 minutes devoted to a presentation on a chosen topic. Attendees then break into smaller groups for discussion. “We have a facilitator in each small group and a scribe,” Hedberg said. “This is where we are looking for the community to provide feedback on the topic they were just educated on.”
Petersburg Medical Center (PMC) in Petersburg, a small town on an island in southeastern Alaska, was the first to sponsor a community cafe last November at the Petersburg Public Library. Jeannie Monk, Vice President of the Alaska State Hospital and Nursing Home Association, spoke on the changing landscape of healthcare in rural communities and how communities must pivot to accept these changes. Phil Hofstetter, PMC CEO, added his perspective following Monk’s presentation, Hedberg said.
“When we broke into small groups after their presentation, one of the questions we asked was, ‘As a community member, what healthcare services will keep you in your community?’” Hedberg said. “It was fascinating to hear what they want and what they perceive, and their thoughts on healthcare.”
AK-SORH held community cafes twice that day at PMC on the same topic. The morning cafe had 50 to 60 people, and the afternoon cafe had around 30 people participating, Hedberg said. “It’s important that the cafes have a limited number of participants, because in a smaller group, it’s easier to draw out the quiet voices,” she explained. “You could have a town hall meeting, but it would be harder to have one-on-one conversations. In rural communities, the smaller the group, the more information you can draw out of them.”
Hedberg called the first community cafes “a fantastic start,” especially since they included a wide swath of community members. “It enabled us to see where their knowledge base was so that we can target our education and further that conversation,” she said.
PMC, which is Petersburg’s only hospital, is a CAH built in 1917 that was last remodeled 30 years ago, Hedberg said. “One thing we all realized is if Petersburg wants a new hospital it needs to be community-driven,” she said. “And we need to know what services they want so we can build it into that plan.”
The first cafes were such a success that AK-SORH was invited back to PMC in February to do another, this time on the promise of new telehealth offerings. The group experienced a tele-psychiatry visit through a camera, Hedberg said, then broke into smaller groups to answer questions including “what types of services are you looking for?” and “how much would you be willing to pay for these services?” Since then, PMC has launched tele-psychiatry services.
PMC helped advertise the cafes by making posters and putting them in local venues and promoted them on their weekly radio session and their website, which helped lead to their success, Hedberg said.
The idea for AK-SORH’s community cafes sprang from those sponsored by the state’s Office of Substance Misuse and Addiction Prevention (OSMAP), which visited more than 20 Alaskan communities “to educate them on opioids and to hold conversations on how to resolve the issue,” Hedberg said. “From that, a lot of communities formed their own coalitions and OSMAP created a statewide strategy plan drawn out of the responses from those communities.”
“This is not a new idea—it’s just how you organize it,” Hedberg added. “Consensus meetings, listening sessions, community cafes— there’s all different types of them, but for small rural communities, the cafes are a great way to have a structured format to both educate and receive feedback on any topic.” AK-SORH funds its community cafe work through Flex money for travel, and SORH money for staffing time, she said.
Since the cafes that were held in Petersburg, other communities have expressed interest in them, she said.
“It’s exciting when you bring a community together and through that relationship comes feedback, and out of that comes these new service delivery models,” Hedberg concluded. “We’ll continue to do these as long as communities ask us to facilitate these conversations on healthcare topics that are impacting the community—we hope to do these forever!”
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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.
Believe it or not, NOSORH is already planning the 2019 Annual Meeting! The Annual Meeting will take place in Albuquerque, New Mexico, on October 16-17 at the DoubleTree by Hilton Albuquerque. This year’s goal is to provide a more diverse meeting than ever before. NOSORH staff is looking to develop educational strategies that offer a variety of session types to be delivered in a new and exciting way. More information regarding the meeting will be provided via email and posted to the NOSORH website as it becomes available.
Discounted rooms are available to meeting participants at the rate of $114 per night plus taxes until September 24, 2019. Use the code “Group Guest NOSORH” to reserve a room online or by phone, Click here or call 800-445-8667. We look forward to seeing you in Albuquerque! If you have questions, please contact Matt Strycker or Trevor Brown.
The RHIhub has a new Evidence-based Toolkit on Rural Philanthropy. Developed in collaboration with the NORC Walsh Center for Rural Health Analysis, this toolkit is designed to help rural organizations create and maintain partnerships with philanthropies. Includes guidance on conducting outreach, model programs, emerging strategies, and a wealth of resources.
RHIhub is hosting a webinar related to Rural Philanthropy on Tuesday, February 26, 2019 at 1:00 pm Eastern. This webinar will feature two rural organizations discussing their experiences with building relationships with foundations and will delve into some of the strategies outlined in the toolkit.
Two new articles are featured in the Rural Monitor:
The toolkit on Rural Care Coordination has been updated, created and maintained in partnership with the NORC Walsh Center for Rural Health Analysis and the University of Minnesota Rural Health Research Center. Substantial revisions have been made to the Implementation module, which delves into considerations for workforce and staffing, different populations, quality improvement, and adopting a whole-person mindset, among other things.
Several of Topic Guides have also been updated:
Did you know?
The RHIhub features conferences with open calls for presentations each week in the RHIhub This Week newsletter, but you can also see the full list here: https://www.ruralhealthinfo.org/events/calls