Health Policy: Rural Health Agenda S.2408

keywords and phrases:  rural health care, funding/grants, federal funding, health policy, access to healthcare providers, Medicare, National Health Service Corps (NHSC), telemedicine, loan repayment models, social determinants of health (SDOH)

Outline

• The 2019 Rural Health Agenda
• Rural American Health Corps Act
• Rural Health Innovation Act
• Telemedicine Across State Lines Act
• Why these are important bills to track as healthcare practitioners
• Supporting publications for acupuncturists to be included as a distinct profession in these acts
• Rural Health Program Resources--general info
• Rural Health Program Resources--current grant applications are open from the HRSA Office of Rural Health Policy!!

The Hospital Practice Handbook Project

2019 Rural Health Agenda—One to Watch

Senator Marsha Blackburn (TN) began championing the Rural Health Agenda in August 2019. The Rural Health Agenda’s goal is to address health care delivery challenges in the rural United States of America to maintain quality care "close to home".

The rural Health Agenda includes 3 bills:

1. The bipartisan Rural America Health Corps Act, cosponsored by Senators Dick Durbin (D-Ill), Kevin Cramer (R-N.D.), Doug Jones (D-Ala) and Lisa Murkowski (R-Alaska).
2. The Rural Health Innovation Act is co-sponsored by Senator Murkowski.
3. The Telemedicine Across State Lines Act is cosponsored by Senator Cramer.

If you work or want to work in a rural area, contact your representative to get Licensed Acupuncturists (LAcs) added to the list of qualifying health care professionals. Get help from your state association on how to write a letter to your representatives.

Rural American Health Corps Act

Quote:

“This bipartisan bill, led by Senators Blackburn and Durbin, and cosponsored by Cramer, Jones, and Murkowski would enhance the National Health Service Corps (NHSC) to include a Rural America Healthcare Corps to incentivize academic medical centers and health care graduates to rotate through underserved communities, and a range of sites would qualify for the program. “The Rural America Health Corps Act…creates a new loan repayment program titled ‘NHSC Rural Provider Loan Repayment Program.’ Includes a range of providers such as nurse practitioners and physician assistants. Ensures practitioners would be eligible for loan repayment on a sliding scale, based on the severity of the shortage in that area. Waives any associated income tax liability for the loan repayment program.  Other than these provisions, the program would follow the same rules as the current NHSC program.” -Blackburn Unveils Rural Health Agenda

Rural Health Innovation Act

“This bill, co-sponsored by Senator Murkowski, incentivizes communities to leverage their existing resources to provide for the community’s urgent care needs. It would incentivize the establishment of robust Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) staffed with physician interns and residents, physician assistants, nurse practitioners, nurse midwives, and other advance-practice nurses. These facilities would have the equipment needed to triage and stabilize patients in an emergency, including a lab, X-ray machine, cardiac monitors, and more. These centers would serve the walk-in urgent care needs for a rural community and serves as a triage center and staging facility for necessary air or ambulance transports to area emergency departments.”   “This bill would also create a collaborative federal, state and local pilot program to expand rural health departments to meet urgent care needs, including a full range of necessary equipment, so these robust health departments can serve the walk-in urgent care needs of rural communities and serve as a triage center and staging facility for air or ambulance transports to area emergency departments.” -Blackburn Unveils Rural Health Agenda

Telemedicine Across State Lines Act

This bill “instructs the Secretary of Health and Human Services (HHS) to initiate a rulemaking to create federal telemedicine program best practices: the Secretary should consult with a range of stakeholders, including technology experts, primary care providers, specialists, academic medical centers, emergency medicine providers, federal agencies with expertise in this area, and more. The Secretary must report on the progress of the rulemaking to the Congressional committees of jurisdiction. [This bill] creates a grant program to incentivize the expansion of effective telemedicine programs to reach rural communities.” -Blackburn Unveils Rural Health Agenda

Sources for above information: 

• “Blackburn Unveils Rural Health Agenda” and “Blackburn Eyes National Telehealth Programs in Rural Health Strategy” 
• Sponsor of all 3 bills that make the “Rural Health Agenda” is Senator Marsha Blackburn (TN)
• The bill is S.2408.
• The “bill tracker” for this you can watch at this link.

Why do I want to see Licensed Acupuncturists (LAcs) included as providers in the Rural Health Corps Act, the National Health Service Corps, and the Rural Health Innovation Act?

• LAcs can help with the “opioid epidemic” by providing non-drug pain management treatment in community clinics and emergency departments (ED) as part of the healthcare team.
• makes available more access to non-drug pain management (opioid crisis)
• LAcs are well-trained in the health and wellness paradigm. They support positive health behaviors and manage chronic pain conditions through both treatment and teaching patients self-care, which may include acupressure, movement, breathing techniques, support healthful eating and positive healthy lifestyle behaviors
• Besides serving the rural and underserved communities this is an option for student loan repayment. Graduate school programs for master’s and doctorate degrees in our field are long and expensive.

The Bureau of Labor and Statistics (BLS) unique Standard Occupational Code (SOC) for our profession is 29-1291 Acupuncturist.

Some supporting published research and standards of care guidelines on acupuncture for pain management and wellness

• McPherson, F et al (2016) Health Perception and Wellness Behavior Survey among Military Beneficiaries. Ann Psychiatry Ment Health 4(2): 1060. 
• Acupuncture and Opioids
• The White Paper: Acupuncture's Role in Solving the Opioid Epidemic
• Fan AY, Miller DW, Bolash B, Bauer M, Faggert S., He H, Li YM, Matecki A, Camardell L, Koppelman MH, Stone J, McDonald J, Meade L, Pang J. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management--White Paper 2017. J Integr Med. 2017; 15(6): 411-425. https://doi.org/10.1016/S2095-4964(17)60378-9

• Acupuncture in ED reference information
• Interview with Dr. John Burns about his ED acupuncture feasibility study research paper and work.
• Burns JR, Kram JJ, Xiong V, Stark Casadont JM, Mullen TA, Conway N, Baumgardner DJ. Utilization of acupuncture services in the emergency department setting: a quality improvement study. J Patient Cent Res Rev. 2019; 6:172-8. 10.17294/2330-0698.1688
• https://digitalrepository.aurorahealthcare.org/jpcrr/vol6/iss2/5/
• Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, volume 18, issue 1, 1 January 2017, pages 169-178, https://doi.org/10.1093/pm/pnv114
• Acupuncture, general evidence-based publications
• “Overview of Treatment Guidelines and Clinical Practice Guidelines that Recommend the Use of Acupuncture: A Bibliometric Analysis”. The Journal of Alternative and Complementary Medicine. Vol.24(8). 6.18.2018. published online ahead of print. http://doi.org/10.1089/acm.2018.0092
• “Acupuncture: An Overview of the Scientific Evidence” from Evidence-based Acupuncture is available at their website.
• “Acupuncture Evidence-based Summary: Pain” by Evidence-Based Acupuncture
• The Acupuncture Evidence Project –A Comparative Literature Review 2017. Follow the link for a pdf download option. 
• Acupuncturists are an integral part of the VA Whole Health Programs
• What is the Whole Health program at the VA?
• I recommend watching this presentation of Dr. Tracy Gaudet’s work with this field-forwarding initiative to learn more. Dr. Gaudet’s lecture here is the NIH’s Stephen E. Strauss Distinguished Lecture, given November 29^th, 2018, “Transforming Veteran’s Health Care: The Whole Health System”.
• 3-minute YouTube video of Wayne Jonas, MD, Samueli Institute
• on shifting U.S. culture of health to one of community health, wellness, and prevention over disease-care-only as part of this idea of "on human flourishing".  It is a complex problem from health culture to socio-economic disparities. 

Rural Health Program Resources

• To learn more about issues in rural health, check out the National Rural Health Association and their annual conference. 
• The National Rural Health Resource Center
• The American Hospital Association (AHA) and their Rural Advocacy Agenda
• Health Resources and Services Administration (HRSA)’s Rural Health Program includes program funding and grants  HRSA is a branch of the U.S. federal Health and Human Services (HHS).
• The Rural Health Information Hub (a clearinghouse for information on rural health supported by the HRSA)  and their YouTube channel 

For those of you already working in rural communities…

There are funding opportunities, including grants from the HRSA Rural Health Program. These are currently open for applications! 

Source: HRSA Rural Health Funding Opportunities. 

The “Rural Health Network Development” has the following funding opportunities open:

• HRSA-20-025 | Office of Rural Health Policy
• Application Accepted: 08/14/2019 to 11/25/2019
• Projected Award Date: 07/01/2020
• The “Rural Health Network Development Plan”
• HRSA-20-026 | Office of Rural Health Policy
• Application Accepted: 07/23/2019 to 11/29/2019
• Projected Award Date: 07/01/2020

The ECHO Model--Hub and Spokes

Want to see a very successful telemedicine program set up with “hubs” of experts and “spokes” reaching providers in rural and/or underserved communities? 

• Check out the University of New Mexico’s ECHO model. When I worked at the Madigan Interdisciplinary Pain Management Clinic, I participated as a hub expert in my discipline (TCM, acupuncture) as part of my team’s field (interdisciplinary pain management, functional rehabilitation, and return-to-work care model).
• YouTube video (one minute): https://youtu.be/VAMaHP-tEwk 

More Blogposts Related to Health Policy

• The Fall Health Policy News Roundup
• Summer Health Policy News
• The CHRONIC Care Act
• Congressional Integrative Health and Wellness Caucus
• Moving Beyond Medications, the Infographic
• The VA Whole Health Program
• 37 Attorney Generals Push Incentives for Non-Pharm Pain Management Therapies
• The White Paper: Acupuncture's Role in Solving the Opioid Epidemic

More on Federal Occupational Codes: BLS and VA Staffing Codes published in 2018

• BLS SOC is 29-1291 Acupuncturist
• Acupuncturists are an integral part of the VA Whole Health Programs

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