The
Health Resources and Services Administration's (HRSA) Office of
Rural Health Policy (ORHP) was authorized by Congress in December
1987 to promote better health care in rural America. Congress authorized
ORHP to advise the Department of Health and Human Services (HHS)
on matters affecting rural hospitals and health care, coordinate
rural HHS activities, and maintain a national information clearinghouse.
ORHP works within government at Federal, State and local levels,
as well as with Tribal Nations and the private sector including
associations, foundations, providers and community leaders, to increase
access to and improve the quality of rural health care.
ORHP administers a range of programs designed
to sustain and improve access to quality health care services for
rural communities. ORHP currently manages 12 competitive grant programs,
the Frontier Extended Stay Demonstration model, and the Denali Commission
resources. Through these grant programs, as many as 5,000 rural
and frontier communities are assisted in improving access to health
services. The Office continuously considers emerging trends, research,
and policy to respond to the unique health care needs of rural communities.
In the past 5 years, ORHP has added grant programs, engaged in policy
making, and sponsored important research to address the challenges
faced in accessing health care in rural America. Highlights of recent
successes include the following.
- In 2001, the HHS Rural Task Force was created,
comprising representatives from each of the HHS agencies and staff
offices that meet quarterly to discuss HHS programs and policies
that impact the provision of health care and human services for
rural Americans. The Task Force examines ways to improve and enhance
HHS services for the 54 million rural Americans through the examination
of current program investment, regulatory policy and barriers
to providing services, and the development of strategies to improve
services. On July 26, 2002, the HHS Rural Task Force Report, "One
Department Serving Rural America," was released. The Report highlighted
the Task Force's findings and made a number of recommendations
for strengthening the Department's rural focus. Many of the cross-cutting
recommendations have been implemented or are underway.
- ORHP serves as a policy and informational resource
in order to sustain and improve access to quality health care
services for rural communities. Recent rural health policy successes
include recognition of the unique role of Rural Health Clinic
and Federally Qualified Health Center pharmacies in rural areas,
protection of sole community hospital status when specialty hospitals
enter the market, definition of rural training tracks within residency
programs, and inclusion of Critical Access Hospitals and small
rural hospitals in the CMS hospital quality reporting initiative.
- Over the past 5 years, the rural research program
has conducted timely research well aligned with issues that are
important to advancing rural health concerns. The Office's expanded
portfolio includes research about the rural population, covering
such issues as health disparities, health promotion, and mental
and behavioral health. In 2003, ORHP developed a new mini-grant
research program designed to provide support for policy-relevant
rural health research by entities just entering the field.
- ORHP has supported the National Rural Recruitment
and Retention Network (3RNet) which has expanded its membership
from 12 to 45 States over the past 5 years. During FY 2004, this
not-for-profit organization helped recruit 753 health professionals
(459 physicians) into 611 underserved communities.
- The National Advisory Committee on Rural Health
and Human Services (NAC) is a 21-member citizens' panel of nationally
recognized experts that provide recommendations on rural health
and human services issues to the Secretary. In 2003, ORHP successfully
integrated the human services into the NAC. Within the past 5
years the NAC has concluded 10 field visits and 5 reports to the
Secretary covering topics such as access to mental health, oral
health, program development, health care financing and workforce
development. The Committee uses the field visits to focus on the
yearly report topics and to devote time to site visits and presentations
by the host community.
- In 2001, ORHP developed and implemented the
Delta Initiative created by the FY 2001 appropriation, including
a new grant program for eight States in the Delta Regional Authority,
and implementation of the small hospital improvement program,
to be piloted in the Mississippi Delta. Since it was implemented
in 2001 to address the unique needs of providers in the Mississippi
Delta region, the Delta Rural Health Performance Initiative has
provided on-site technical assistance to 62 of the 122 eligible
small rural hospitals. This project has helped hospitals improve
their financial, operational and clinical performance and is a
model for performance improvement in other areas of the country.
- ORHP is tasked with establishing and maintaining
the Rural Assistance Center (RAC), which acts as a clearinghouse
and single point of entry for all rural health and human services
programs within the Department. Created in 2002, the RAC assists
rural communities in addressing unmet health needs. The RAC provides
current information on funding opportunities, policy developments,
meetings, best practices, and other information to rural citizens.
A current estimate of the total number of clients served annually
is over 150,000.
- Since the implementation of the Small Hospital
Performance Program (SHIP) in 2003, ORHP has made more than $45
million available to help 1,450 small rural hospitals in 46 States
and Puerto Rico improve HIPAA compliance, quality and patient
safety, as well as make investments in computers, software and
technical assistance.
- In July 2003, ORHP, the Agency for Healthcare
Research and Quality (ARHQ), and the Substance Abuse and Mental
Health Services Administration (SAMHSA) funded an Interagency
Agreement with the Institute of Medicine to provide an independent
and unbiased assessment of the quality of health care in rural
America, and to develop a conceptual framework for a core set
of services and the infrastructure necessary to deliver those
services to rural communities. The report, titled Quality Through
Collaboration: The Future of Rural Health, was released in November
2004 and makes recommendations for an agenda for quality improvement
in a rural setting, and identifies the performance characteristics
that model 21st century community rural health systems should
meet.
- In 2003, ORHP planned and managed the Agency's
first efforts in working with Regional Commissions through a Regional
Commissions Conference. ORHP continues its efforts to collaborate
with the four regional commissions across the United States. These
commissions view access to health care as critical to economic
development in rural communities.
- "Rural Health Works" is a project that helps
communities, counties and States understand and measure the importance
of health care to the local economy. Over the past 5 years 44
States have received training, 20 States are working with their
local communities, and a number of economic impact analysis studies
have been completed.
- ORHP has been instrumental in supporting the
Sowing the Seeds of Hope, a seven-State project that provides
mental, behavioral, and substance abuse counseling and assistance
to farmers and ranchers in the Midwest region of the country.
The project works to provide preventive and therapeutic services
for farm family members.
- In 2003, ORHP supported the development of
the Healthy People 2010 companion document for rural communities,
identifying best practice models for health promotion and disease
prevention.
- In the fall of 2004, HRSA's US-Mexico border
efforts were incorporated into ORHP. Soon after, HRSA-through
the Office of Rural Health Policy- became the lead Federal agency
within HHS in hosting Border Binational Health Week October 11-17,
2004. The theme for this first-ever border-wide week was "Families
in Action for Health" and it brought together more than 29 Federal
partner agencies and programs, and 310 community organizations-who
carried out more than 200 community events, 28 policy forums,
59 health fairs, and 43 trainings/workshops that reached more
than 65,000 individuals in 14 sister cities.
- Through funds provided under the Frontier Extended
Stay Clinic (FESC) Cooperative Agreement, a consortium of rural
providers in frontier areas of Alaska have come together to demonstrate
the viability of a new provider type for remote frontier areas.
With the assistance of the Alaska Center for Rural Health and
a provider workgroup, the clinics have identified the characteristics
of the extended stay services they currently provide, developed
a log to track the services and have begun collecting data on
the services provided.
- In 2004, ORHP implemented three new grants
programs:
- Public Access to Defibrillation Grant Program-
The intent of this grant program is to support projects that
will increase public access to emergency medical devices and
services.
- Rural Emergency Services Training and Equipment
Assistance Grant Program- The REMSTEP grant program seeks to
fund eligible entities that propose to develop improved emergency
medical services (EMS) in rural areas.
- Network Development Training Grant Program-
The Planning Grant Program provides 1 year of funding to rural
communities that seek to develop a formal integrated health
care network and that do not have a significant history of collaboration.
- A recently funded study of the Rural Health
Care Services Outreach (Outreach) Grant Program examined accomplishments
of grantees (years 1994-1996) 4 to 7 years following the expiration
of grant funding. The study found that after an average of almost
6 years of post-grant operations, 86 percent of the Outreach Program
consortia were still operational. Approximately 60 percent of
the surviving consortia exhibited at least two out of the three
study criteria including the use of client revenues and third
party reimbursement to support operations. The vast majority of
initial consortia activities and services (88 percent) were still
available up to 4 years later, a variety of new and expanded efforts
have been initiated and stable funding was developed for 46 percent
of surviving consortia.
- The Rural Hospital Flexibility Program is a
Federal initiative that provides funding to State Governments
to strengthen rural health. Through the Flex program ORHP has
provided assistance to bring the total number of rural facilities
converted to Critical Access Hospitals to over 1, 000 in order
to help stabilize their financial status and preserve access to
hospital care in rural communities.
- In the past year, ORHP has encouraged rural
TA Centers to coordinate their technical assistance activities.
In 2004, ORHP convened all of the Office's TA providers to seek
opportunities to collaborate and consider ways to improve efficiency.
As a result of this discussion, a planning team of TA experts
was selected to continue these efforts. Almost 1 year later, the
planning team has developed a TA Center directory and provided
services to assist TA Centers with referrals to other TA Centers.
The planning team will join the rest of the TA Centers again in
September 2005 to update the other centers on their progress and
gather feedback about next steps in TA Center coordination.
Office of Rural Health Policy
Strategic Plan FY 2005-2010
Vision, Mission, and Strategic Goals
ORHP Vision
ORHP's vision is to improve the health of Americans by providing
national leadership in increasing access to quality health care
in rural America.
Mission
The mission of the ORHP is to sustain and improve access to quality
health care services for rural communities. In addition, the Office
coordinates access to quality health care activities along the U.S.-Mexico
Border.
Goals
To measure its accomplishments the Office has established the following
three long-term goals:
Goal 1: Improve the health and wellness of
people living in rural communities and in the U.S.-Mexico border
region
Goal 2: Improve the financial viability of
small rural hospitals, rural health clinics, and other rural providers
Goal 3: Sustain and improve access to outpatient,
inpatient, pharmaceutical and emergency room care for rural communities
and along the U.S.-Mexico border region
Goals, Objectives, Strategies
Goal 1: Improve the health
and wellness of people living in rural communities and in the U.S.-Mexico
border region
Objective 1.1: |
Coordinate rural policy and
programs across the Department of Health and Human Services
(HHS) and advise the Secretary on policy and regulatory issues |
How We Will Accomplish
Our Objective
- Staff the HHS Rural Task Force
- Address the difficulties of providing health
care in rural communities by managing the Office's grant programs
as authorized by Congress
- Analyze the equity of Medicare payment policies
to rural hospitals and other provider types
- Modernize and effectively manage ORHP's information
systems and grant making process
- Staff the National Advisory Committee on Rural
Health and Human Services and oversee the production of the Committee's
annual reports
Objective 1.2: |
Coordinate border health programs
and activities across HRSA and advise the Administrator on border
health issues |
How We Will Accomplish
Our Objective
- Strengthen HHS/HRSA relationships with the
U.S.- Mexico Border Health Commission and other partners by playing
a lead role in the planning and implementation of Border Binational
Health Week
- Assist in capacity building and community development
for all HRSA programs and activities along the U.S.- Mexico Border
- Convene the HRSA border grantees to review
best practices and identify gaps in HRSA programs
- Lead the HRSA Border Workgroup and play a key
role on HHS Interagency Action Team
- Encourage collaborative efforts between the
four State Offices of Rural Health in border States with HRSA
border health grantees and the border community through technical
assistance, information dissemination, outreach, working with
key border partners, and general support of border health activities
- Work to expand the capacity of the health care
safety-net in the U.S.-Mexico border region
- Support immunization programs on the U.S.-Mexico
border
Objective 1.3: |
Improve access to the full
range of available programs, funding, and research for rural
communities and other rural stakeholders |
How We Will Accomplish
Our Objective
- Maintain a national rural health and human
services clearinghouse, the Rural Assistance Center (RAC), for
collecting and disseminating information as authorized by Congress
- Create and maintain a technical assistance
Web site through the RAC that focuses on Delta States Grant funding
opportunities
- Maintain a technical assistance Web site through
the RAC that focuses on border health information
- Promote innovative models for health services
delivery in rural communities
- Support rural mental health research and services
through grant programs, research and partnerships
- Implement a balanced research portfolio that
studies critical issues such as: health/wellness, financing of
rural providers, access to care, quality and health workforce
- Support research studies that encourage new
investigators to enter the field of rural health
- Support the Delta Region States through technical
assistance and community-based programs to address specific health
needs
Objective 1.4:
|
Improve Rural
Health Quality |
How We Will Accomplish
Our Objective
- Promote quality in rural communities by working
with the national quality establishment and the rural health care
community to support the implementation of recommendations from
the Institute of Medicine report on Future of Rural Health: Quality
through Collaboration
- Through State FLEX grantees, provide technical
assistance to develop quality improvement programs and publicize
them in the community
- Emphasize wellness and prevention in all appropriate
ORHP grant programs
- Through technical assistance and information
dissemination, increase the number of rural providers and communities
currently serving or interested in serving rural elders through
a rural program of all inclusive care (PACE) model
- Ensure that provider-specific quality measures
are rural appropriate or include rural-specific measures
- Assist small rural hospitals in the Delta Region
with operational, clinical, and financial improvements in order
to increase the quality of services provided
Objective 1.5:
|
Foster Networking |
How We Will Accomplish
Our Objective
- Support networks by encouraging collaboration
among rural hospitals and safety net providers through relevant
grant programs
- Work with other Federal partners, private foundations,
universities, associations, and private organizations to encourage
collaboration among rural or Border interests
- Foster collaboration, reduce duplication and
eliminate gaps in ORHP technical assistance by integrating the
Office's efforts in technical assistance through conference calls
Goal
2: Improve the financial viability of small rural hospitals, rural
health clinics and other rural providers
Objective 2.1:
|
Improve financial viability of small rural hospitals |
How We Will Accomplish
Our Objective
- Support multiple technical assistance projects
to increase the proportion of small rural hospitals and critical
access hospitals with positive operating margins
- Support rural research projects on hospital
financing issues
Objective 2.2:
|
Improve financial
viability of small rural hospitals |
How We Will Accomplish
Our Objective
- Work with Rural Health Clinics on issues that
relate to MMA changes or initiatives including Health Information
Technology (HIT) and managed care contracting
- Collaborate with CMS regarding on-going development
and refinement of Medicare Advantage and Prescription Drug Benefit
policy and procedures
- Collaborate with CMS regarding rural provider
education on payment changes, Medicare Advantage and Prescription
Drug Benefit
- Collaborate with HRSA leadership to formulate
policy and support outreach for the MMA
- Support direct assistance to rural providers
on understanding MMA changes through presentations at local, State
and national meetings
- Monitor development and evaluation of MMA demonstration
projects with a rural focus
- Work with HRSA's leadership to format policy
and support outreach of the MMA
Goal 3: Sustain and improve
access to outpatient, inpatient, pharmaceutical and emergency room
care in rural communities and along the U.S.-Mexico border region
Objective 3.1:
|
Develop capacity
for rural and border health infrastructure at the local provider,
community and State levels |
How We Will Accomplish
Our Objective
- Support community-level consultation and financial
feasibility studies through technical assistance and State grantees
- Seek to increase access to capital for rural
communities
- Work with rural providers, community leaders
and State grantees to develop an understanding of how and where
to best implement advancements in HIT
- Provide technical assistance for local providers,
rural communities and State rural EMS and trauma coordinators
Objective 3.2:
|
Improve access
to pharmacy services for rural and U.S.-Mexico border communities |
How We Will Accomplish
Our Objective
- Establish outreach and partnering efforts related
to raising awareness about the expansion of the 340B pharmacy
program to more than 300 rural hospitals
- Provide technical assistance and best practices
to improve access to pharmacy services in rural areas
- Explore issues and trends in access to pharmacy
services for rural communities
Objective 3.3:
|
Improve the distribution
of health professionals in rural communities and within the
U.S.-Mexico border region |
How We Will Accomplish
Our Objective
- Continue to support services and activities
that specialize in the recruitment and retention of rural health
professions
- Implement and conduct research studies that
examine issues relating to the recruitment and retention of rural
provider
|