RURAL
HEALTH
Programs included in this section are:
RURAL
HEALTH ACTIVITIES
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
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%) |
|
|
|
|
|
|
|
|
2010:
13% |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Focus resources and services
on diseases and conditions with
the greatest health disparities |
27.
IV.A.1 |
Increase
by 1% annually the number of people served
through Outreach Grants |
655,257 |
776,880 |
675,300 |
627,120 |
777,000a |
Oct-08 |
785,000 |
NA |
|
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%) |
|
|
|
|
|
|
|
|
2010:
35% |
27.
V.B.1 |
Increase
by 0.5 percentage point annually the average
operating margin of critical access hospitals |
-10.2% |
-9.6% |
0.5
% point over FY 05 |
-8.8% |
0.5%
point over FY 06 a |
Sept-08 |
0.5%
over FY 07 |
NA |
|
Efficiency
Measure |
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 |
23.36% |
14.8% |
24.5% |
Sept-08 |
25%
a |
Sept-09 |
26% |
NA |
|
|
Appropriated
Amount
($
Million) |
$142.1 |
$144.2 |
|
$160.0 |
|
$160.1 |
$160.1 |
$16.9 |
|
Notes:
a
The FY 07 target in the FY 08 Congressional Justification
was changed to reflect a full-year continuing resolution
for FY 07.
NA
= FY 09: Not applicable as no funding is requested.
Rural Health programs were reduced due to the investment
contained in the rural provisions of the Medicare
Modernization Act of 2003.
INTRODUCTION
The
following long-term and annual goals and measures
have been identified to use in assessing the Office
of Rural Health Policy’s (ORHP) performance. Also
shown below is an efficiency measure for ORHP. (This
does not include the Black Lung and Radiation Exposure
Screening programs, which will be shown 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.
By 2010, reduce to 13.9% the proportion of rural residents
of all ages with limitation of activities caused by
chronic conditions.
(Baseline
- 2000: 14.67%)
This
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 00 was 14.6%. By 2010, the
goal is to reduce this proportion to 13.9%.
27.IV.A.1.
Increase by 1% annually 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 04 the program served 655,257 individuals.
In FY 05, the program served 766,880 individuals.
In FY 06, the Outreach program served 629,120 individuals,
just below the target of 675,300. (See section below
on “Targets Substantially Exceeded or Not Met.”)
This measure does not have a FY 09 target because
the program is not proposed for funding.
Long-Term
Objective: Increase collaborative efforts to improve
the capacity and efficiency of public health and health
care systems
27.2.
By 2010, increase to 35% the proportion of critical
access hospitals with positive operating margins.
(Baseline
- 1999: 10%)
This
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 02, 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. The Rural Hospital
Flexibility program, upon which this measure is based,
is not proposed for funding in FY 09.
27.V.B.1.
Increase by 0.5 percentage point annually 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 05,
CAHs had an average operating margin of -9.6 percent.
In FY 06, the average operating margin improved to
-8.8 percent. This measure does not have a FY 09
target because the program is not proposed for funding.
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 04, the baseline year,
the return on investment was 23.36 percent. The return
on investment in FY 05 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. This measure does not have a FY
09 target because the Rural Hospital Flexibility program
is not proposed for funding.
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 08 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 by 1% annually the number of people served
through Outreach Grants.
FY
06 Target: 675,300
FY
06 Result: 627,120
The
difference between the target and results in FY 06
is due to rising health care costs that have occurred
at the same time that the program funding has remained
level. One step taken to align targets and performance
was to assess targets and adjust them in light of
past performance and anticipated resources. In addition,
the program is assessing targets and results to determine
if they fully reflect the broad range of direct service
delivery programs under this authority. The impact
of this result is that fewer persons than anticipated
had access to care through this program.
RURAL
HEALTH POLICY DEVELOPMENT
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Utilize trend data to assist in
targeting program resources toward goals |
28.
V.
A.1 |
Conduct
and disseminate policy relevant research on
rural health issues. |
26 |
30 |
30 |
30 |
30 |
Sept-08 |
30 |
30 |
|
|
Appropriated
Amount
($
Million) |
$8.9 |
$8.8 |
|
$8.7 |
|
$8.7 |
$8.6 |
$8.7 |
|
INTRODUCTION
This
measure assesses how productive the Office is in producing
research reports that informed its policy activities.
The research reports produced by the Office play a
key role that inform HRSA, HHS and others about the
impact of health care policy on rural communities.
This
performance measure supports HRSA’s Strategic Plan
Goal V of improving the public health and health care
systems by using trend data to assist in targeting
program resources toward goals. The performance measure
also supports HHS Strategic Goal 4 of supporting scientific
research.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Utilize trend data to assist in targeting
program resources toward goals
28.V.A.1.
Conduct and disseminate policy relevant research on
rural health issues.
The
program produced 30 research projects in FY 06 and
FY 07, exceeding the targets. The increase in the
number of studies over 04 is due to an expanded work
as a result of a new program that funds single-year
research awards and an expansion in the number of
research centers funded from six to eight beginning
in FY 05. In FY 09 the target will remain at 30.
The
30 reports in FY 07 represented a full range of rural
health services projects with a particular focus on
issues connected to the implementation of the provisions
in the Medicare Modernization Act of 2003, most notably
the potential rural implications and benefits of the
new Medicare prescription drug benefit and the transition
toward offering more health coverage options under
Medicare Advantage. The studies also continue to
examine the sustainability of small rural hospitals,
including their low volume, and assuring quality through
improving patient safety and reducing medical errors.
Through the policy research, ORHP expects to predict
the impact of the payment reforms on rural citizens,
their hospitals and communities and, most importantly,
to identify options for changes to lessen any negative
effects while also identifying positive outcomes of
the MMA provisions for increasing services for rural
Medicare beneficiaries. Other ongoing reports inform
the policy discussion on improving the health of rural
citizens by ensuring access to health promotion programs,
rural health clinics, and mental health care. The
FY 09 target is 30 reports.
RURAL
HEALTH OUTREACH AND NETWORK DEVELOPMENT GRANTS
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Focus resources and services on
diseases and conditions with the greatest health
disparities |
29.
IV.
A.1 |
Increase
by 1% annually the number of people served through
Outreach Grants. |
675,498 |
682,253 |
675,300 |
627,120 |
777,000 |
Oct-08 |
635,000 |
NA |
|
|
Appropriated
Amount
($
Million) |
$39.6 |
$39.3 |
|
$38.9 |
|
$38.9 |
$48.0 |
|
|
INTRODUCTION
This
measure assesses how well the grants administered
under this authority affect rural residents. The
various grant programs administered under this authority
focus on a range of health issues from improving access
to care to recruitment and retention of health care
providers to improved coordination of services. The
measure focuses on how many rural residents are served
by the program. The measure supports HRSA’s Strategic
Plan Goal IV of eliminating health disparities. The
performance measure also supports HHS Strategic Goal
1 of improving the safety, quality, affordability
and accessibility of health care, including behavioral
health care and long-term care. Providing improved
guidance and information to grantees on performance
expectations and technical assistance to grantees
are strategies used to improve performance.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Focus resources and services on diseases
and conditions with the greatest health disparities
29.IV.A.1.
Increase by 1% annually 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 04 the program served 655,257 individuals.
In FY 05, the program served 766,880 individuals.
In FY 06, the Outreach program served 629,120 individuals,
just below the target of 675,300. (See section below
on “Targets Substantially Exceeded or Not Met.”)
This measure does not have a FY 09 target because
the program is not proposed for funding.
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Increase by 1% annually the number of people served
through Outreach Grants.
FY
06 Target: 675,300
FY
06 Result: 627,120
The
difference between the target and results in FY 06
is due to rising health care costs that have occurred
at the same time that the program funding has remained
level. One step taken to align targets and performance
was to assess targets and adjust them in light of
past performance and anticipated resources. In addition,
the program is assessing targets and results to determine
if they fully reflect the broad range of direct service
delivery programs under this authority. The impact
of this result is that fewer than anticipated had
access to care through this program.
RURAL
HOSPITAL FLEXIBILITY GRANTS
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Increase the collaborative efforts
to improve the capacity and efficiency of public
health and health care systems |
30.V.
B.1 |
Increase
by 0.5 percentage point annually the average
operating margin of critical access hospitals. |
-10.2% |
-
9.6% |
0.5
% point over FY 05 |
-8.8% |
0.5
% point over FY 06 a |
Sept-08 |
0.5
% point over FY 07 a |
NA |
|
30.V.
B.2 |
Appropriate
rural facilities will be assisted in converting
to Critical Access Hospital (CAH) status to
help stabilize their financial status. |
930 |
1,100 |
1,185 |
1,277 |
1,286
a |
1,282 |
1,284 |
NA |
|
30.V.
B.3 |
Facilities
and communities will be assisted in the development
of networks. |
1,181 |
1,209 |
1,250 |
2,326 |
2,400
a |
2,533 |
2,600 |
NA |
|
|
Number
of Rural Hospital Flexibility grants |
94 |
92 |
|
92 |
|
107 |
107 |
NA |
|
|
Appropriated
Amount
($
Million) |
$39.5 |
$39.2 |
|
$63.5 |
|
$63.5 |
$37.9 |
NA |
|
Notes:
a
The FY 07 target in the FY 2008 Congressional
Justification was changed to reflect a full-year continuing
resolution in FY 07.
INTRODUCTION
These
measures assess the performance of the Office’s rural
hospital grant programs. The various grant programs
administered under this authority focus on working
with the grantees to assist Critical Access Hospitals
and the communities they serve. The measures focus
on increasing the annual operating margin, assisting
hospitals in the conversion to CAH status and the
formation of networks of care involving CAHs. Providing
improved guidance and information to grantees on performance
expectations and technical assistance to grantees
are strategies used to improve performance.
These
performance measures supports HRSA’s Strategic Plan
Goal V of improving the public health and health care
systems by increasing collaborative efforts to improve
the capacity and efficiency of public health and health
care systems. The performance measure also supports
HHS Strategic Goal 1 of improving the safety, quality,
affordability and accessibility of health care, including
behavioral health care and long-term care.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Increase the collaborative efforts to
improve the capacity and efficiency of public health
and health care systems
30.V.B.1.
Increase by 0.5 percentage point annually 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 05, CAHs
had an average operating margin of -9.6 percent.
In FY 06, the average operating margin improved to
-8.8 percent. This measure does not have a FY 09
target because the Rural Hospital Flexibility Grant
program is not proposed for funding.
30.V.B.2.
Appropriate rural facilities will be assisted in converting
to Critical Access Hospital (CAH) status to help stabilize
their financial status.
Conversion
of appropriate rural facilities to CAH status will
help sustain the rural health care infrastructure
to provide access to high quality care for rural Medicare
beneficiaries. This is a core component of the Flex
program. Meeting statutory requirements for certification
and Conditions of Participation for CAHs enables the
facility to be reimbursed on the basis of reasonable
cost. This demonstrably improves financial performance
of these most vulnerable facilities, thereby sustaining
access.
Conversion-related
activities have been a major emphasis of the program.
As the program has matured, additional emphasis has
been placed on quality and performance improvement,
improving existing CAH operations, and development
of community-level collaborative relationships (including
EMS) which strengthen rural healthcare. The program
expects the potential growth in the number of conversions
to slow in the coming years with the total universe
of conversions expected to peak at approximately 1,300.
There were 1,277 CAHs in FY 06 and 1,282 in FY 07,
exceeding the target in both years. This measure
does not have a FY 09 target because the Rural Health
Hospital Flexibility program is not proposed for funding.
30.V.B.3.
Facilities and communities will be assisted in the
development of networks.
Building
relationships between CAHs and other providers is
a critical component of infrastructure and systems
development to sustain viable delivery capability
in rural communities. Network development is promoted
to reduce duplication, reduce overhead costs, improve
services and improve quality of care. In FY 06, ORHP
exceeded its target goal of 1,250 by assisting 2,326
facilities/communities in the development of networks.
As the total number of CAHs reaches its expected peak
at just over 1,200, the program emphasis is moving
more toward network development activities. As a
result, the number of facilities and communities assisted
in network development is increasing and the FY 07
target reflects that. This measure does not have
a FY 09 target because the Rural Health Hospital Flexibility
program is not proposed for funding.
STATE
OFFICES OF RURAL HEALTH
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Increase collaborative efforts to
improve the capacity and efficiency of the public
health and health care systems. |
31.
V.
B.1 |
Increase
the number of communities receiving technical
assistance from a State Office of Rural Health. |
4,603 |
4,655 |
4,450 |
4,699 |
4,700 |
Oct-08 |
4,750 |
4,775 |
|
31.
V.
B.2 |
Increase
the number of States that have an identified
focal point for rural recruitment with a national
source of applications |
42 |
45 |
43 |
46 |
44 |
Oct-08 |
48 |
49 |
|
|
Appropriated
Amount
($
Million) |
$8.4 |
$8.3 |
|
$8.1 |
|
$8.1 |
$8.0 |
$8.1 |
|
INTRODUCTION
The
measures are used to assess the performance of the
Office’s investment in the 50 State Offices of Rural
Health. The program provides matching grants to each
of the 50 States to support the ongoing efforts of
creating a single point of contact within the State
for rural health issues. The performance measures
focus on two key activities of the grantees. The
first looks at how many communities receive technical
assistance from the grantee. The second looks at
how many States have identified a focal point for
the recruitment and retention of health professionals
in rural areas which has long been an important need
for rural communities. The program uses an annual
grantee meeting to focus attention on performance
expectations and to provide a forum for grantees to
share approaches used to improve performance.
These
measures support HRSA’s Strategic Plan Goal V of improving
the public health and health care systems by increasing
the collaborative efforts to improve the capacity
and efficiency of the public health and health care
systems. The measures also support HHS Strategic
Goal 1 of improving the safety, quality, affordability
and accessibility of health care, including behavioral
health care and long-term care.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Increase collaborative efforts to improve
the capacity and efficiency of the public health and
health care systems.
31.V.B.1.
Increase the number of communities receiving technical
assistance from a State Office of Rural Health.
This
measure is important because rural communities and
providers are often isolated and have unique technical
assistance needs. By providing this technical assistance,
a State Office of Rural Health (SORH) is equipping
rural communities with the tools and resources needed
to coordinate rural health at the local level. The
SORH enables a community to create localized solutions
to problems which in turn strengthens the rural health
delivery system one community at a time. This goal
reflects one of the program’s core functions. The
program established a baseline of 4,120 communities
in FY 03. In FY 06, the State Offices of Rural Health
provided technical assistance to 4,699 rural communities
exceeding the target of 4,450. The FY 09 target for
the number of communities receiving technical assistance
is 4,775. The FY 09 target for number of States
that have a focal point for recruitment is 49.
31.V.B.2.
Increase the number of States that have an identified
focal point for rural recruitment with a national
source of applicants.
This
measure was chosen because rural communities experience
greater challenges in recruitment of health professionals.
With at least 20 percent of the population living
in rural areas and less than 11 percent of the nation’s
physicians practicing in non-metropolitan areas, the
goal of fostering rural recruitment activities is
a key component to many activities of the State Offices.
Workforce shortages hamper attempts to address other
pressing health care problems in rural America. A
strategy that many State Offices use to meet this
goal is to participate in a national rural recruitment
program, such as the National Rural Recruitment and
Retention Network (3RNET). The program established
a baseline with FY 03 data that indicated 41 States
having identified a focal point for rural recruitment.
The number increased to 46 in FY 06, exceeding the
target. The FY 09 target is 49.
RADIATION
EXPOSURE SCREENING AND EDUCATION
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
32.1 |
Percent
of RECA successful claimants screened at RESEP
centers.
(Developmental) |
|
|
|
|
|
|
|
|
TBD |
32.2 |
Percent
of patients screened at RESEP clinics who actually
receive RECA claims.
(Developmental) |
|
|
|
|
|
|
|
|
TBD |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
32.
I.
A.1 |
Increase
the total number of individuals screened per
year.
(Baseline-2994) |
1,859
|
1,551 |
2,147 |
1,464 |
2,255 |
Nov-08 |
1,700 |
1,800 |
|
32.
I.
A.2 |
Increase
the total number of telephone inquiries
to RESEP clinics based on expanded nationwide
outreach efforts.
(Developmental) |
|
|
|
|
|
|
|
|
TBD |
Efficiency
Measure |
32.E |
Average
cost of the program per individual screened |
$1,062
baseline |
$1,046 |
$893 |
$1,084 |
$850 |
Nov-08 |
$810 |
$760 |
|
|
Appropriated
Amount
($
Million) |
$2.0 |
$2.0 |
|
$1.9 |
|
$1.9 |
$1.9 |
$1.9 |
|
INTRODUCTION
The
measures focus on identifying possible patients who
may have suffered radiation poisoning and providing
needed services to them for screening. The measures
also focus on helping to determine if eligible patients
might be eligible to seek compensation through the
filing of Radiation Exposure and Compensation Act
claims. The annual measure focuses on increasing
the number of individuals screened each year. The
data from the performance measures are used to refine
the actual guidance for the grantees to focus more
explicitly on the activities that directly impact
the ability to identify and screen affected patients.
A key strategy to improve performance is to increase
RESEP national outreach to spread the word about the
program. The program is also partnering with the
Department of Justice to collect data in support of
long-term performance measures.
The
measures support HRSA’s Strategic Plan Goal I of improving
access to care and expanding the capacity of the health
care safety net The measures also support HHS Strategic
Goal 1 of improving the safety, quality, affordability
and accessibility of health care, including behavioral
health care and long-term care.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Expand the capacity of the health care
safety net
32.1.
Percent of RECA successful claimants screened at RESEP
centers. (Developmental)
This
long-term measure reflects RESEP's primary purpose
to screen and educate those that might be eligible
for compensation under the Radiation Exposure Compensation
Act. The measure will be determined by comparing
the number of successful RECA claimants screened through
RESEP centers (i.e. the numerator) with the total
number of successful RECA claimants (i.e. the denominator).
This is a developmental measure since there is not
sufficient data currently to set a baseline and target.
32.2.
Percent of patients screened at RESEP clinics who
actually receive RECA claims.
(Developmental)
This
long-term measure reflects the program's efforts to
accurately screen and refer individuals potentially
eligible for RECA claims. Findings from RESEP's screenings
must be confirmed outside the screening program through
definitive diagnostic tests in order for an individual
to receive benefits. The measure will be determined
by comparing the number of successful RECA claimants
screened through RESEP centers as reported to the
Department of Justice (i.e. the numerator) with the
total number of RECA claimants screened at RESEP centers
as reported to the Department of Justice (i.e. the
denominator). This is a developmental measure since
there is not sufficient data currently to set a baseline
and target.
32.I.A.1.
Total number of individuals screened per year.
This
annual measure indicates the total number of individuals
screened at RESEP centers. This measure defines screening
as including: 1) occupational history, 2) medical
history, 3) physical examination, 4) diagnostic testing
(when appropriate), and 5) access to a range of comprehensive
services including outreach, education, case management,
referrals for treatment, and assistance in applying
for RECA compensation. The baseline for this measure
is 1,859 individuals screened in FY 04. The number
of individuals screened in FY 05 is 1,551, below the
FY 05 target of 2,045. In FY 06, the number of individuals
screened is 1,464, below the FY 06 target of 2,147.
(See section below on “Targets
Substantially Exceeded or Not Met.”) The FY 09
target is 1,800 individuals screened.
32.I.A.2.
Total number of telephone inquiries to RESEP clinics
based on expanded
nationwide
outreach efforts. (Developmental)
The
second annual measure expands the program’s local
outreach activities to a nationwide approach attempting
to identify individuals potentially exposed, who no
longer reside in the local area. Though some RESEP
grantees currently collect information from each inquiry
to determine where the person heard about the RESEP
program, there is no program-wide data collection
system yet. Thus, this measure is developmental as
the program seeks to implement a streamlined process
for data collection.
32.E.
Average cost of the program per individual screened
The
efficiency measure compares the total costs of the
program to the program's outcome of getting individuals
screened. The average cost per individual screened
is based on the fiscal year dollars spent to pay for
the screenings. The costs include all education and
outreach efforts as well as the costs of the screening
exams. The baseline is $1,062 for FY 04. In FY 05
the program showed an average cost of $1,046. In
FY 06 the program showed an average cost of $1,084
which was above the target of $893. (See section
below on “Targets Substantially Exceeded or Not Met.”)
The FY 09 target is $760.
TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Total number of miners screened.
FY
06 Target: 2,147
FY
06 Result: 1,464
Measure:
Average cost of the program per individual screened.
FY
06 Target: $893
FY
06 Result: $1,084
The
program has not met its target for its annual goals
in FY 06 of increasing the total number of individuals
screened or for its related efficiency measure of
reducing the average cost per individual screened.
The lower number of individuals screened is driven
primarily by changes in the target population. The
number of uranium miners served by the program has
decreased. In some cases, the population of former
uranium mine workers is aging rapidly and a cohort
of potential patients has died. In other cases, the
population of former uranium mine workers has diffused
away from the original mine sites. This, in turn,
affected the efficiency measure since there were higher
per unit costs. The program is devising new outreach
strategies to identify where this patient population
has relocated and to make them aware of available
screening sites.
BLACK
LUNG CLINICS
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
33.1 |
Increase
the percent of miners that show functional improvement
following completion of a pulmonary rehabilitation
program.
(Developmental) |
|
|
|
|
|
|
|
|
TBD |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term
Objective: Expand the capacity of the health
care safety net |
33.
I.
A.1 |
Increase
the number of miners served each year. |
NA |
10,790
baseline |
10,862 |
11,444 |
10,933 |
Aug-08 |
11,550
a |
11,575 |
|
33.
I.
A.2 |
Increase
the number of medical encounters from Black
Lung each year. |
NA |
20,844
baseline |
20,983 |
19,165 |
21,121 |
Aug-08 |
21,269 |
21,375 |
|
|
Number
of Black Lung grants |
15 |
15 |
|
15 |
|
15 |
15 |
15 |
|
Efficiency
Measure |
33.E |
Increase
the number of medical encounters per $1 million
in federal funding. |
2,600 |
3,570
baseline |
3,590 |
3,333 |
3,610 |
Apr-08 |
3,630 |
3,650 |
|
|
Appropriated
Amount
($
Million) |
$6.0 |
$6.0 |
|
$5.9 |
|
$5.9 |
$5.8 |
$5.9 |
|
Notes:
a
The target previously published in the FY 08
Congressional Justification for the number of miners
served has been increased to reflect recent performance.
INTRODUCTION
The
measures for the Black Lung Program assess how well
the program meets the needs of miners suffering from
Black Lung disease. Many miners suffering from this
disease live in isolated rural areas or economically
challenged communities in which access to health care
services is difficult and in which expertise among
the existing clinicians on black lung disease is limited.
The measures focus both on long-term and short-term
goals. The long-term goal assesses improved pulmonary
function for coal miners. The short-term goal assesses
increasing services to victims of black lung disease.
Performance data is used to examine how to refine
program guidance annually to focus grantees on ways
to improve services and increase efficiency. Two
other strategies used to improve performance include
developing a mechanism to collect data on the location
of miners to better target resources, and enhancing
outreach efforts.
The
measures support HRSA’s Strategic Plan Goal I of improving
access to care and expanding the capacity of the health
care safety net The performance measure also supports
HHS Strategic Goal 1 of improving the safety, quality,
affordability and accessibility of health care, including
behavioral health care and long-term care.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Expand the capacity of the health care
safety net
33.1.
Increase the percentage of miners that show functional
improvement following completion of a pulmonary rehabilitation
program. (Developmental)
Functional
improvement will be measured using the 6 minute walk
pre/post test, applying uniform standards of measurement
established by the American Thoracic Society (ATS).
The 6 minute walk test is one of several tests available
as an objective indicator of functional improvement;
measuring the distance the patient can walk during
a 6 minute period. For the purposes of this measure
the patient will take the test prior to starting the
pulmonary rehabilitation program and again after the
completion of the program. An improvement in the
post-test indicates an improved functional capacity
in the patient, an indication of improved quality
of life.
33.I.A.1.
Increase the number of miners served each year.
A
miner served is any one with a history of coal mine
employment that receives at least one medical encounter
at a clinic during the year. It is often difficult
to encourage miners to come into the Black Lung clinics
for the initial visits. However, grantees will devote
a greater emphasis on program outreach towards affected
populations. The baseline for this measure is 10,790
for 2005. In FY 06, the program saw 11,444 miners,
exceeding the target of 10,862. The FY 09 target
is 11,575.
33.I.A.2.
Increase the number of medical encounters from Black
Lung each year.
To
improve the quality of life of miners, it is important
for clinics to provide ongoing, consistent care once
the initial screening is conducted. The program expects
the number of medical encounters to increase proportionate
to the number of miners served. The baseline for
this measure is 20,844 for 2005. The program totaled
19,165 medical encounters in FY 06, missing its target
of 20,983. The drop in encounters is attributed to
increased costs per encounter due to rising medical
costs. The FY 09 target is 21,375.
33.E.
Increase the number of medical encounters per $1 million
in federal funding.
The
number of medical encounters per million dollars increased
by 37%, from 2,600 in FY 04 to 3,570 in FY 05. In
FY 06 the number of encounters per million dollars
was 3,333, falling short of the target. The Program
offers technical assistance to grantees. The technical
assistance consultants look at specific activities
and offer suggestions for cutting costs while maintaining
the same level of services. The program is looking
into methods for collecting data that will highlight
cost efficiencies to better identify best practices
and target technical assistance. The FY 09 target
is 3,650. |