As Rural America Ages, Volunteers Give a Hand

 By Jenni Bergal

© The Pew Charitable Trusts

Dave Brown, 75, a volunteer for the Harpswell Aging at Home team, insulates the floor under a house in coastal Maine. Volunteers in the graying state are helping seniors remain in their homes.

HARPSWELL, Maine, October 26, 2016 — Dianna Haller loved her small, one-story home in this coastal fishing town, but it didn’t love her back. The living room floor was sagging. Snakes and mice were wriggling in through a gap under the front door. And mold was seeping in through a crawl space full of standing water.

Haller, a 65-year-old widow with chronic obstructive pulmonary disease who uses an oxygen generator, was rushed to the emergency room several times this year because of breathing problems her doctors said were exacerbated by the mold. She badly needed help, but couldn’t afford the repairs.

Last month, the Harpswell Aging at Home team came to Haller’s rescue. The group of volunteers in their 60s and 70s, dubbed the Dream Team, went to work insulating and shoring up the floor, sealing the foundation, rebuilding the front door, installing rain gutters and storm windows, replacing ceiling lights that were fire hazards, and doing other work — all for free.

Across Maine, volunteers are stepping up to help rural seniors like Haller who want to remain in their homes as they age. Some work with local governments or nonprofits. Others have simply gotten together to offer a hand. Many of them are seniors themselves.

And what they are doing can be emulated by the rest of the nation, as the number of people 65 and over is projected to explode from 48 million to 77 million between now and 2035.

Maine’s rural population is older than that of most other states. Demographers project that a third of the state’s population will be 65 and over by 2032.

And the challenges confronting Maine as it deals with an aging population are turning up elsewhere. Rural America is aging faster than its urban counterparts, as fewer children are born and younger, working-age adults are moving away.

John Cromartie, a U.S. Department of Agriculture geographer, said the problems would be particularly severe in New England, the Great Plains and Midwest farming states.

“The rural areas are the canary in the coal mine,” he said. “In lots of cases, older people don’t have the means to leave, even if they wanted to. And many want to stay because it’s where they were born or settled down and raised a family.”

Local governments cannot afford to pay for all the services needed to help seniors stay in their homes.

State governments face the same dilemma. And retrofitting a house for aging people can be expensive. It can cost $800 to $1,200 to widen a doorway to accommodate a wheelchair, $1,600 to $3,200 for a ramp, and up to $12,000 for a stair lift.

That’s what makes Maine’s growing volunteer network so valuable.

“There isn’t enough money in Maine to deal with this problem,” said Jess Maurer, executive director of the Maine Association of Area Agencies on Aging. “It’s going to have to be community by community, using volunteers and public and private resources.”

Already, more than 60 communities throughout the state have started or are in the process of starting programs to help seniors age in their homes, Maurer said.

Some volunteers offer rides. Others grow and donate fresh fruit and vegetables. Some offer respite to caregivers. And many, like the Harpswell Aging at Home team, perform home maintenance or do chores that residents can’t do themselves.

Sandy Markwood, CEO of the National Association of Area Agencies on Aging, called what’s going on in Maine a model for other states.

“These are really small communities doing incremental changes that make a huge difference to the people who live there. They’re doing it with existing resources and the human capital they have there.”

As in other rural areas, many of Maine’s seniors live in multilevel homes without a bathroom or bedroom on the first floor.

When they can no longer drive, there’s little, if any, public transportation available, and grocery stores, pharmacies and doctors can be far away. Experts say older adults who stay in their homes often do less maintenance as the years go by, so their houses often deteriorate.

“The challenges in rural areas are probably the most severe,” said Susan Reinhard, a senior vice president at the AARP Public Policy Institute. “Isolation is a serious problem. Depression goes up. Physical health declines.”

For Haller, the Dream Team not only improved her house but improved her health. She is breathing better and hasn’t been to the hospital since they did the work. “You used to smell the mold all the time,” she told volunteers who arrived to make more repairs this month. “Now I can smell the salt air.”

At the Forefront of a Trend

In Maine, people 65 and over made up 19 percent of the state’s population last year, up from 16 percent in 2010. And many state officials and advocates foresaw the coming trend.

In 2013, the Maine Council on Aging and House Speaker Mark Eves held a series of roundtable discussions about the issue with leaders of business, finance, housing, philanthropy and state and local government.

That provided a framework for a summit on aging that drew 400 people in 2014, and resulted in the Maine Aging Initiative, in which groups across the state try to come up with ways to tackle the challenges posed by an older population.

Among the Initiative’s recommendations: Urging communities to help the elderly remain in their homes.

Advocates for seniors in Maine, New Hampshire and Vermont also share information about ways to help keep seniors in their homes and beef up efforts to make communities more age-friendly. The partnership is now working with more than a hundred communities in the three states.

And in 2015, Eves, a Democrat, and state Sen. David Burns, a Republican, created a legislative caucus on aging. Since then, the Legislature has passed or funded 16 measures to help older adults, including more funding for home-delivered meals and in-home care workers and expanded property tax relief for seniors.

“One of our goals wasn’t just to pass legislation, but to elevate the profile of these issues affecting our aging population so people can take the initiative,” Eves said. “If you fast-forward 10 years, I think Maine will have some lessons for other states, particularly rural ones, about how to do it well.”

Lending a Hand

Many of the lessons in Maine are to be found in the volunteer and civic groups that have sprung up or stepped in to help seniors continue to live at home.

The Dream Team in Harpswell was modeled after another home modification team, The Regulars, a group of retiree Habitat for Humanity volunteers who have been helping seniors in mid-coast Maine since 2014.

Last year, the John T. Gorman Foundation gave Bath Housing, a regional housing authority, a $156,000 grant to help seniors make home modifications. The agency used $69,000 from the grant to contract with Habitat to expand The Regulars’ work.

Like the Dream Team, The Regulars are an eclectic group of retirees, including a lawyer, an engineer, an FBI agent and an English professor, who volunteer for Habitat.

They work twice a week, rain or shine or snow — which is why they’re called The Regulars. They have taken on 60 jobs throughout the area.

They’ve done everything from widening doors and fixing gutters to replacing floors to installing ramps. Habitat pays for materials, trains the volunteers, and provides liability insurance, staff support and a van with tools.

Many seniors who’ve gotten help from The Regulars live in substandard housing or mobile homes, which often are not insulated and can be freezing during long, cold Maine winters.

“One guy who had five bypass operations had no heat. We got the furnace working,” said George Shaw, 76, a volunteer. “We’re these people’s peers. We make them feel like they’re being helped by their own community.”

Kathy Smith, development director for Habitat for Humanity-7 Rivers Maine, said it’s not just rural seniors living in modest homes or trailers who need help. The group has assisted people who live in larger houses that are worth more, but don’t have the income to maintain them.

The Village Lodge Handy Brigade, run by a team of Masonic lodge brothers whose ages range from 19 to the mid-70s, assists seniors in the small farming town of Bowdoinham and in two other towns with everything from changing lightbulbs and installing smoke detectors to replacing storm windows and making minor carpentry fixes.

“This program helps people maintain their independence and keeps their property from deteriorating,” said Peter Warner, 60, the Masons’ lodge master.

Warner said that since his team, whose motto is “One light bulb at a time,” organized in February, it has helped about 30 seniors. On a recent fall day, two team volunteers visited the home of a grateful 76-year-old woman and her disabled sons to replace ceiling tiles in a bathroom ruined by a plumbing leak.

“Older folks don’t want to be seen as needing help, but with the Handy Brigade, they know of them and may even have someone in their family who was a Mason,” said Patricia Oh, who coordinates senior services for Bowdoinham and works with the team.

‘Life Experience to Share’

Cumberland is another Maine town committed to helping seniors remain in their homes. It budgets about $50,000 a year for an aging in place initiative that includes a program that sends trained volunteers to spend time with seniors who feel lonely or who live with a caregiver who needs a break.

Susan Gold, the town’s Aging in Place coordinator, said the program offers social and psychological support, and isn’t income-based. “Providing a friend isn’t something you can buy, even if you have a million bucks,” she said.

For Brian and Judy Hathaway, both 76, a weekly visit from volunteer Heidi Kleban makes a big difference.

Judy Hathaway suffered a stroke nearly 10 years ago. She has difficulty communicating and often gets frustrated. Her caregiver husband said he desperately needs some time away, and when Kleban visits he can take off and know his wife is having a good time playing cards or taking walks. “Heidi comes in and Judy just melts. She loves her,” he said.

Kleban, 46, said she volunteers because she enjoys the company of older people. “They have a whole life experience to share,” she said. “And besides, who else would have taught me gin rummy?”

Study Suggests Farm Traffic Vehicle Accidents Could Be Reduced By More Than Half

State policies that increase lighting and reflecting recommendations for farmers can significantly reduce accidents involving tractors and other farm vehicles

Newswise, October 24, 2016 — A new study from the University of Iowa College of Public Health has found that traffic accidents involving farm vehicles in the Midwest would decrease by more than 50 percent if state policies required more lighting and reflection on those vehicles.

The study by the college’s Great Plains Center for Agricultural Health (GPCAH) compared rates of farm equipment–related crashes in nine Midwestern states in the context of the states’ policies on lighting and marking vehicles.

Those states report an average of more than 1,100 farm vehicle-related crashes each year, often causing severe or fatal injuries.

The American Society of Agricultural and Biological Engineers (ASABE) has issued standards on lighting and marking farm vehicles to promote safety among all roadway users.

The standards suggest certain numbers of headlights, taillights, turn signals, and other exterior lighting visible to other drivers, as well as the number and size of reflective markers.

The organization’s standards are not all required by state laws, but many of the nine states in the study have adopted some of them or have their own policies that address the same issues.

The researchers found fewer crashes in states with more stringent lighting and marking policies, in particular those that adhered to ASABE’s standards.

States with greater compliance with ASABE standards had 11 percent fewer farm equipment road crashes than states with lesser compliance. Illinois law and policies were most compliant with the standards, whereas Missouri's were the least.

Using data from 2005 to 2010, researchers estimate the number of accidents annually would be cut 60 percent, from 972 to 385, if states implemented policies that increased compliance with ASABE standards by 25 percent over current policies.

In Iowa, the study estimates crashes would decrease from an annual average of 164 to 65, or by 60 percent

.

Marizen Ramirez, UI professor of occupational and environmental health and lead investigator on the study, says most farm vehicle–passenger vehicle collisions occur because most passenger vehicle drivers are not familiar with farm vehicles and cannot correctly gauge the speed at which they are moving. This often leads to vehicles approaching too quickly and attempting to pass in unsafe conditions, which can result in a crash.

She says the likelihood of a crash is greater in October and November, when more farm vehicles are on the road for the harvest and the sun sets earlier.

“We know that farmers spend a lot of time on the roads, especially during planting and harvest,” she says. “Our research shows that lighting and marking—like reflectors, slow-moving vehicle emblems, and taillights—can help farm vehicles stand out on roadways so passenger vehicle operators are more likely to see them. It helps to do all that you can to increase your visibility on the road, especially when farmers may be driving during and after dawn or dusk.”

Program Will Train Mental Health Providers, Improve Health Care in Rural Missouri

August 11, 2016--According to the U.S. Census, 37 percent of Missourians live in rural communities and have limited access to health care, particularly mental health care.

A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.

“Placing psychology doctoral candidates within primary health care agencies will enhance the current infrastructure in Missouri’s communities and improve comprehensive care for patients,” said Laura Schopp, professor of health psychology and co-principal investigator for the training program.

“For example, a patient with diabetes may need psychological help to address mental barriers that could be preventing them from changing their behavior. Having psychologists working side-by-side with primary care providers should result in better patient outcomes and savings to the state in Medicaid dollars.”

The funding will support several training partnerships and placements throughout Missouri including:
• Missouri Department of Mental Health and Community Mental Health Centers
• Missouri Division of Vocational Rehabilitation
• Family and Community Medicine Clinics in the MU School of Medicine
• MU Thompson Center for Autism and Neurodevelopmental Disorders
• Harry S Truman VA Medical Center
• Fort Leonard Wood Army Post

“Previous research has indicated the need for a comprehensive approach to health care,” Schopp said. “If we treat the whole person—mind and body—patients will have significantly better health outcomes. This new training program will allow people to help patients that do not have access to the psychological care that they need.”

The HRSA Graduate Psychology Education program at MU is being led by Brick Johnstone, professor of health psychology in the MU School of Health Professions. Along with Schopp, the program is being assisted by Eric Hart, associate clinical professor of health psychology and training director; Renee Stucky, professor at the Comprehensive Pain Management Center in the MU School of Medicine; Nikole Cronk, associate teaching professor of family and community medicine in the MU School of Medicine; and psychologists from the MU department of health psychology.

This project is supported by HRSA of the U.S. Department of Health and Human Services under grant number 1D40HP29827-01-00 for $699,772 over a three-year period. As required by the grant, MU provides some benefits to graduate students who contribute to this work. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 

Sweet Potato Crop Shows Promise as Feed and Fuel

Newswise, August 3, 2016 --As some Florida growers try to find new crops and the demand for biofuel stock increases globally, University of Florida Institute of Food and Agricultural Sciences researchers have found that sweet potato vines, usually thrown out during harvest, can serve well as livestock feed while the roots are an ideal source for biofuel.

This could be a key finding for the agriculture industry in Florida and to biofuel needs worldwide, said post-doctoral researcher Wendy Mussoline.

“The agriculture industry in Florida is looking to find new, viable crops to replace the citrus groves that have been diminished by the greening disease,” Mussoline said.

“Potato farmers are also trying to find new crops that offer both biofuel alternatives as well as food and/or animal feed opportunities. They are conducting field trials on several varieties of sweet potatoes to determine if they are an economically viable crop that they can market.”

According to a newly published study by professor Ann Wilkie and Mussoline, an industrial sweet potato variety (CX-1) may do the trick.

Currently, 99 percent of the ethanol produced in the United States comes from corn or sorghum, the study says. But scientists and business interests are considering highly productive alternatives such as sweet potatoes for biofuel. Although China produces 81 percent of the world’s sweet potatoes, U.S. sweet potato production reached a record high of 3.2 billion pounds in 2014, according to the U.S. Department of Agriculture.

Wilkie and Mussoline, both researchers in the UF/IFAS soil and water sciences department, found that CX-1 is a superior choice as a dual-purpose crop than the so-called “table” varieties – which people would normally eat -- known as Beauregard and Hernandez.

They determined this by putting CX-1, Beauregard and Hernandez, through multiple tests in the field and laboratory in Gainesville.

“The CX-1 roots have higher starch content and thus higher potential for fuel ethanol yields than the table varieties,” Mussoline said.

The study demonstrated CX-1’s value as animal feed and promotes the industrial sweet potato crop as a dual-purpose crop that could be used for both fuel ethanol -- from the starchy roots -- and nutritious animal feed -- from the vines.

“Although this would be a ‘new’ feedstock for biofuels in the U.S., sweet potato is currently used in other countries; for example, China and Brazil, use it as a biofuel feedstock,” Mussoline said.

“The sweet potato is a high-yielding crop suited to tropical and subtropical climates that requires minimal fertilization and irrigation, and the CX-1 industrial cultivar offers superior potential for feed and fuel,” Wilkie said.

The research was sponsored by the Florida Department of Agriculture and Consumer Services Office of Energy.

The new study is published online in the Journal of the Science of Food and Agriculture, http://bit.ly/29RLhpS.

Telephones Can Bring Cancer Genetic Counseling to Rural Women

New follow up study shows cancer genetic counseling delivered by telephone as good as in-person counseling

Newswise, June 24, 2016 — Ever since Angelina Jolie used cancer genetic counseling and testing to learn about her risk for hereditary breast and ovarian cancer, many other women have chosen to do the same.

But for women in rural communities, traveling to meet in person with cancer genetic counselors can be time-consuming and expensive. Now, a new study shows that getting cancer genetic counseling over the phone can be just as good as getting the same counseling in person.

The work, led by Anita Kinney, PhD, RN, at The University of New Mexico Comprehensive Cancer Center, was published in the Journal of Clinical Oncology.

All the women who took part in the study were at increased risk for hereditary breast or ovarian cancer. The researchers divided the women into two groups.

One group traveled to meet in person with a cancer genetic counselor and the other received counseling over the telephone. Both groups of women received teaching materials and letters about their risk in the mail. With the women’s permission, letters about their risk and how to manage it were mailed to their doctors.

One year after their counseling, the study assessed how the women felt: their anxiety and cancer-related distress, and how much control and how informed they felt about their risk and medical recommendations. It also tracked how many women went on to get genetic testing. Both groups benefited similarly from genetic counseling.

“This study provides important evidence that telephone counseling is an effective alternative to in-person counseling,” says Kinney. “It can help to make cancer genetic services more widely accessible, which is an important consideration in rural states like New Mexico. We hope that our study’s results will help increase health insurance coverage of telephone counseling so that more cancer patients and their family members can benefit from potentially lifesaving cancer risk information.”

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About Anita Kinney, PhD, RN
Anita Kinney, PhD, RN, is a Professor in the Division of Epidemiology and Biostatistics, Department of Internal Medicine, and is The Carolyn R. Surface Endowed Chair in Cancer Control and Population Sciences at University of New Mexico School of Medicine. She serves as Associate Director for Cancer Control and Population Sciences at the UNM Cancer Center. She also serves as the lead investigator for Cancer Care Delivery Research at the New Mexico Underserved/Minority site. Trained at the University of Pennsylvania, UT-Houston School of Public Health, the University of North Carolina-Chapel Hill, and the National Cancer Institute, Dr. Kinney is an international and highly acclaimed expert in cancer prevention and public health. Her overarching research goal is to understand variation in cancer risk; determinants of risk and outcomes; and to use this information to develop effective interventions that facilitate access to quality care, promote cancer equity, informed decision-making and positive changes in health behaviors, cancer prevention care delivery and survivorship. With a particular emphasis on breast, ovarian and colorectal cancers, she is making improvements in reducing cancer risk and the way cancer care is delivered in diverse populations.

About the UNM Comprehensive Cancer Center
The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius. One of the premier cancer centers nationwide, the UNM CCC has 125 board-certified oncology physicians, forming New Mexico’s largest cancer care team. It treats about 60 percent of adults and virtually all the children in New Mexico diagnosed with cancer — more than 10,000 people— from every county in the state in more than 135,000 clinic visits each year. Through its partnership with the New Mexico Cancer Care Alliance, an “exemplary national model for cancer health care delivery,” the UNM CCC offers access to more than 175 clinical trials to New Mexicans in every part of the state. Annual research funding of more than $72 million supports the UNM CCC’s 129 cancer scientists. Working with partners at Los Alamos and Sandia National Laboratories, Lovelace Respiratory Research Institute, and New Mexico State University, they have developed new diagnostics and drugs for leukemia, breast cancer, ovarian cancer, prostate cancer, liver and pancreatic cancer, brain cancer, and melanoma; garnered 33 new patents and 117 patents pending; and launched 13 new biotechnology companies since 2010. Learn more at cancer.unm.edu.

Study Examines Use of Telemedicine Among Rural Medicare Beneficiaries

Newswise, May 31, 2016 — Although the number of Medicare telemedicine visits increased more than 25 percent a year for the past decade, in 2013, less than 1 percent of rural Medicare beneficiaries received a telemedicine visit, according to a study appearing in  JAMA.

Medicare limits telemedicine reimbursement to select live video encounters with the patient at a clinic or facility in a rural area. Federal legislation has been proposed to expand Medicare telemedicine coverage. 

Ateev Mehrotra, M.D., of Harvard Medical School, Boston, and colleagues examined trends in telemedicine utilization in Medicare from 2004-2013 using claims from a 20 percent random sample of traditional Medicare beneficiaries.

The researchers found that telemedicine visits among rural Medicare beneficiaries increased from 7,015 in 2004 to 107,955 in 2013 (annual visit growth rate, 28 percent); 0.7 percent of rural beneficiaries received a telemedicine visit in 2013. 

Most visits occurred in outpatient clinics; 12.5 percent occurred in a hospital or skilled nursing facility. Mental health conditions were responsible for 79 percent of visits. 

Rural beneficiaries who received a 2013 telemedicine visit were more likely to be younger than 65 years, have entered Medicare due to disability, have more illnesses, and live in a poorer community compared with those who did not receive a telemedicine visit.

“Proposed federal legislation would encourage greater use of telemedicine through expanded reimbursement. In contrast to others, we found that state laws that mandate commercial insurance reimbursement of telemedicine were not associated with faster growth in Medicare telemedicine use. 

Our results emphasize that nonreimbursement factors may be limiting growth of telemedicine including state licensure laws and restrictions that a patient must be hosted at a clinic or facility,” the authors write.

Editor’s Note: This article was supported by an unrestricted gift to Harvard Medical School by Melvin Hall and CHSi Corporation. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Surgery Surprise: Rural Hospitals May Be Safer and Less Expensive for Common Operations

Critical access hospital study suggests local care works well for straightforward surgical cases in uncomplicated patients

Newswise, May 18, 2016— They may be in small towns. They may only have a couple of surgeons. But for common operations, they may be safer and less expensive than their larger cousins, a new study finds.

“They” are critical access hospitals – a special class of hospital that’s the closest option for tens of millions of Americans living in rural areas. And according to new findings published in the Journal of the American Medical Association, having surgery at one of them may be a better bet for most relatively healthy patients than traveling to a suburban or city hospital.

A University of Michigan-led team carried out the analysis of data from 1.6 million hospital stays for four common operations: gallbladder removal, colon surgery, hernia repair and appendectomy.

They compared what happened to patients covered by Medicare who had their operations at 828 critical access hospitals with data from patients treated at more than 3,600 larger hospitals.

The analysis yielded several surprises:

• The risk of dying within 30 days of the operation was the same whether a patient had surgery at a critical access hospital or a larger hospital.
• The risk of suffering a major complication after surgery, such as a heart attack, pneumonia or kidney damage, was lower at critical access hospitals.
• Patients who had their operation at a critical access hospital cost the Medicare system nearly $1,400 less than patients who had the same operation at a larger hospital, after differences in patient risk and pricing were accounted for.
• The patients who had these operations at critical access hospitals were healthier to begin with than patients treated elsewhere, suggesting that critical access hospital surgeons are appropriately selecting surgical patients who can do well in a small rural setting, and triaging more complex patients to larger centers.
• But even after the researchers corrected for differences in pre-operation health, the critical access hospitals still had equal or better outcomes.

Critical eye on critical access

The findings are timely because of a current debate over whether to change the national policies that designate critical access hospitals, and determine how much they get paid for medical and surgical services. Hundreds are these hospitals are in danger of closing, threatening local access to care for millions of Americans.

Currently, the Medicare system essentially subsidizes them by paying them slightly more than the total cost of care, in order to ensure they can stay financially afloat to serve rural areas. Even still, dozens have closed in recent years.

Recent studies of common medical conditions like heart attacks and pneumonia at critical access hospitals have raised questions about how well they care for patients with these conditions. The new study is the first comprehensive look at the surgical care they provide.

“From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care,” says Andrew Ibrahim, M.D., first author of the new study and a VA/Robert Wood Johnson Clinical Scholar at the U-M Medical School.

Ibrahim and senior author Justin Dimick, M.D., MPH, worked on the study with Tyler Hughes, M.D., one of two surgeons at the critical access McPherson Hospital in McPherson, KS and a director of the American Board of Surgery.

Says Hughes, “The goal of the rural surgeon is best care nearest home. Data to assure that the care in rural centers is both safe and cost effective is critical in the decisions the profession faces in providing care to the 20 percent of the U.S. population living in truly rural environments.

This study gives credence to what rural surgeons long suspected -- that well-done rural surgery is safe and cost effective.” Hughes helped the U-M team understand the triage process that surgeons at critical access hospitals use to decide whether to take a case or refer the patient to a larger center.

Says Dimick, “For many years, surgeons have debated whether we should concentrate surgery in a subset of our larger hospitals. The downside of this approach is that patients have to travel far from home for surgery, especially those living in remote areas.

“While it may make sense to travel to a higher volume hospital for a few of the most complex operations, this study shows that having surgery locally is safe for many of our most common surgical procedures.” Dimick, a professor of surgery, leads the Center for Healthcare Outcomes and Policy at U-M and is a member of the U-M Institute for Healthcare Policy and Innovation. 

Other findings from the study:

• Less than 5 percent of surgery patients at critical access hospitals got transferred to larger hospitals, compared with more than a quarter of patients treated for non-surgical issues and studied by other teams.
• Critical access hospital surgery patients were less likely to use skilled nursing facilities after their operations.
• Complex operations such as esophagus or pancreas removal were performed so rarely at critical access hospitals they were not included in the study.

More about critical access hospitals

Under the original provision established by the Medicare Rural Hospital Flexibility Program, hospitals were eligible for critical access designation if they have less than 25 inpatient beds and are more than 35 miles away from another hospital. By meeting these criteria and undergoing critical access designation, hospitals are paid 101 percent of reasonable costs.

They are also exempt from certain other limits on Medicare payment that non-critical access hospitals are subject to. Physicians who practice at critical-access hospitals are also able to receive 115 percent of the usual payment for traditional Medicare patients.

The new research is based on data from the Medicare Provider Analysis and Review file from 2009 to 2013, after nearly all of the current 1,332 critical access hospitals underwent designation.

In addition to Ibrahim, Hughes and Dimick, the study team included U-M statistician Jyothi Thumma, MPH. The research was funded by Ibrahim’s support from the Robert Wood Johnson Foundation and U.S. Department of Veterans Affairs, and by National Institute on Aging grant AG039434. Reference: JAMA Vol. 315, No. 19, DOI:10.1001/jama.2016.5618