Fellow NRHA members:
As the incoming Chair of the editorial board of the Journal of Rural Health, I invite you to read the latest issue. [To access full text of the articles online, click on the "Journal" tab at the top of the page and you will be prompted to log in using your NRHA member user ID and password.] The Journal of Rural Health is one benefit of NRHA membership. Although the Journal is an academic, peer-reviewed journal, NRHA members will likely find many articles of interest in each issue. Here, we summarize four articles in the latest issue to give a sample of the kinds of things that each issue contains and its relevance to NRHA members.
In “Rural Relevant Quality Measures for Critical Access Hospitals” (Casey et al), the authors consider quality measures that may be relevant for Critical Access Hospitals. The authors point out that recently published academic research, critical of the quality provided in CAHs, underscores the acute need to develop a consensus set of measures for the quality of care commonly provided by CAHs (as opposed to, say, PCI among AMI patients). The authors conclude with a call to action: “Lack of relevant measures and low volume are no longer valid reasons for CAHs failing to report quality measures. Public reporting will be a challenge for many CAHs, but the time has come for all CAHs to publicly report on relevant quality measures.” Given recently publicized work critical of CAH quality, research on appropriate measures for CAH is especially relevant.
In “Regional Differences in Prescribing Quality Among Elder Veterans and the Impact of Rural Residence”, Gund and colleagues analyze prescription data for veterans and find that rural veterans were more likely to receive inappropriate prescriptions than urban veterans. Interestingly, this rural-urban gap varied regionally, with rural veterans in the west receiving inappropriate prescriptions less often than urban veterans, while rural veterans in the south and, to a lesser extent, the northeast, receiving more inappropriate prescriptions. The regional differences in the disparity have important implications. As the authors point out, “…national implementation of policy or interventions could be misguided and inefficient, when potential rural disparities are limited to specific geographic regions.”
Two articles are especially policy relevant, given the recent attention in Washington on the finances of CAHs. “Measuring the Performance of Critical Access Hospitals in Missouri Using Data Envelopment Analysis “ (Gautam et al) examines Missouri CAHs and find that they are less financially efficient than PPS hospitals. The authors point out, however, that the relative financial efficiency may not be the only outcome worth considering: “Access to health care and the impact on the local economy provided by these CAHs to the community are also critical indicators for more comprehensive performance evaluation.” Another article, “The Financial Performance of Rural Hospitals and Implications for Elimination of the Critical Access Hospital Program” (Holmes et al), analyzes the financial performance of rural hospitals with a specific focus on the variation by Medicare reimbursement type. The authors predict that the dissolution of the CAH program (as has been floated in national policy discussions) would nearly double the number of CAHs with negative profit margin. [Please indulge my self-mention ;-).]
Other articles will be of interest to most of you, as well. I encourage members to investigate the full table of contents of this – and every – issue of the JRH and as always we welcome feedback on the Journal from the NRHA membership.