Rural Health

Rural Health Activities

Notes:
*   This is a long-term measure with no annual targets.

INTRODUCTION

The long-term and annual goals and measures discussed below have been identified to use in assessing the Office of Rural Health Policy’s (ORHP) performance.  Also discussed below is an efficiency measure for ORHP.  (This does not include the Black Lung and Radiation Exposure Screening programs, which are presented later.)  These measures assess the progress in meeting the following goals:

• Increased access to quality health care services
• Improved access to hospital care for rural residents

These goals support HRSA’s Strategic Plan Goal IV of eliminating health disparities and the HHS Strategic Goal 2.1 of increasing health care service availability and accessibility.  The measure focused on increasing the operating margin of Critical Access Hospitals makes the link between economic viability of these facilities and their ability to continue playing an important safety-net role in isolated rural communities. The program uses performance data to improve program design and delivery.  Strategies include making revisions to program guidance to assure that performance expectations and goals are clear and to focus the attention of grantees on performance improvement and efficiency.  The Program also partners with State Offices of Rural Health to provide technical assistance to grantees.

DISCUSSION OF RESULTS AND TARGETS

Long-Term Objective:  Focus resources and services on diseases and conditions with the greatest health disparities.

27.1.  Reduce the proportion of rural residents of all ages with limitation of activities caused by chronic conditions. 
(Baseline - 2000: 14.67%)

This long-term measure was chosen because rural residents experience greater limitation of activity caused by chronic conditions than urban residents.  A reduction of activity limitation is an indicator of improvement of health status and wellness.  According to the Centers for Disease Control and Prevention, (CDC), the proportion of rural residents of all ages with limitation of activities caused by chronic conditions in FY 2000 was 14.67%.  By 2013, the goal is to reduce this proportion to 13%.

27.IV.A.1.  Increase the number of people served through Outreach Grants.

The Outreach grant program is an effective way to provide services to rural communities to improve health and wellness.  In FY 2004 the program served 655,257 individuals.  In FY 2005, the program served 766,880 individuals.  In FY 2006, the Outreach program served 629,120 individuals, just below the target of 675,300.  In FY 2007, this program served 933,003 individuals, exceeding the target of 777,000. (See section below on “Targets Substantially Exceeded or Not Met.”)  The program reduced the amount of some grant awards to make additional awards to other communities through another program, which increased the number of people served. The program also increased the amount and quality of technical assistance for potential applicants.  The FY 2009 target is 791,000.

Long-Term Objective:  Increase collaborative efforts to improve the capacity and efficiency of public health and health care systems.

27.2.  Increase the proportion of critical access hospitals with positive operating margins.
(Baseline - 1999:  10%)

This long-term measure is used to monitor efforts to increase the financial viability of small rural hospitals.  According to the Flex Tracking Project, 17% of Critical Access Hospitals (CAHs) were operating with positive operating margins in FY 99.  Preliminary analysis of Medicare cost-report data for CAHs shows that progress toward this goal is being made.  In FY 2002, the number of CAHs with positive operating margins had increased to 29%.  As these facilities become more economically viable, they will be more likely to survive long term and therefore continue serving as a key access point for health care in rural communities. 

27.V.B.1.  Increase the average operating margin of critical access hospitals.

This measure is important because an increase in the average operating margin of CAHs will contribute to these hospitals’ financial viability.  CAHs serve as key access points for Medicare beneficiaries in rural areas and also act as the focal point for expanded health care services in rural communities by helping to attract physicians and other health care personnel.  Therefore, the focus on operating margin helps determine the long-term viability of CAHs to continue to perform that access role.  Medicare cost reports show that CAHs had a -14.05% average operating margin in 1999.  Since that time, the Congress has enacted three laws that have included provisions increasing administrative flexibility for CAHs.  It is expected that these changes in the law will help address some of the financial challenges and barriers facing CAHs.  Analysis of Medicare cost report data shows positive progress toward this goal.  In analyzing cost report data for a representative selection of CAHs, these facilities are seeing improved operating margins.  In FY 2005, CAHs had an average operating margin of -9.6 percent.  In FY 2006, the average operating margin improved to -8.8%.  This figure improved to -6.7 percent in 2007, which was better than the FY 2007 target of improving the margin by 0.5% to 8.3 %. 

27.E.  Increase the return on investment of funds by the Rural Hospital Flexibility (FLEX) grant program, as measured by change in total operating margin of critical access hospitals in relation to FLEX dollars invested.

This efficiency measure indicates the return on investment of funds by the Rural Hospital Flexibility grant program as measured by the change in total operating margin of critical access hospitals in relation to the investment of Flex program dollars.  The measure looks at the change in total operating margin for all CAHs from one year to the next relative to the programmatic investment that is specifically focused on finance-related activities to yield a percentage that quantifies return on investment annually.  In FY 2004, the baseline year, the return on investment was 23.36 percent.  The return on investment in FY 2005 was 14.8 percent, which is below the target of 24 percent but still indicative of a positive return on investment for the program. The reduction in overall return on investment may fluctuate year to year as rural hospitals experience significant variability in their patient volume and revenue but these factors tend to balance out to some degree over time.  The return on investment in FY 2006 was 13.4 percent, which was again below the target but still indicative of a positive return.

The Office of Rural Health Policy is looking at a range of options for a new efficiency measure.  New performance data will be collected.  Initial data measurement and analysis will take place in FY 2008 and an assessment of the potential for a new efficiency measure will be done after this analysis takes place.

TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET

Measure:  Increase the number of people served through Outreach Grants.

FY 2007 Target:           777,000
FY 2007 Result:           923,000