Chronicity is a term frequently employed to describe the kinds of health problems that affect patients aged 65 and older. It also can be applied to health workforce challenges that steadily prove difficult to overcome. Rural sections of the United States represent areas that often suffer the effects of being inadequately served as a result of severe shortages of various kinds of health professionals. Mental health offers a good example of where considerably more effort is needed to address the health care needs of residents of rural areas. Compared to urban locales, for example, suicide rates are higher in rural parts of the nation.

Unfortunately, no single magic bullet is available to remedy the fact that as many as one-half of U.S. counties, predominantly located in rural areas, do not have a single psychiatrist to respond to the needs of residents. As an illustration of a recently proposed legislative remedy, the “VA Mission Telehealth Clarification Act” was introduced in the U.S. House of Representatives on June 12, 2019. It has seven co-sponsors for the purpose of authorizing health professional trainees to provide treatment via telemedicine. Proposals of a broader nature would involve allowing Medicare beneficiaries to access mental health services through telemedicine regardless of where they live and without having to leave home.

A different kind of approach would entail helping mental health professionals pay off their educational debt if they agree to work in an area with a shortage of workers. Inadequate reimbursement levels may be a major disincentive for mental health professionals to live and work in rural areas, especially in sections of the country that are remote. A way of addressing the situation would be to consider using peer support specialists who could work with doctors who treat patients using telemedicine. These individuals are neither physicians nor other kinds of health professionals. Instead, they are characterized by having knowledge derived from their own personal recovery process in combination with some formal training to enable them to support patients confronting similar challenges.

Obtaining More Savings From Accountable Care Organizations

The Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in 2018. According to a paper in the June 6, 2019 issue of the New England Journal of Medicine, the savings pace has not proven to be commensurate with Medicare’s fiscal challenges, however, prompting calls for reform. The Centers for Medicare and Medicaid Services (CMS) responded in December 2018, with “Pathways to Success.” Strengthening incentives for ACOs to reduce spending is challenging because the program is voluntary. Some approaches, such as requiring ACOs to bear downside risk for excess spending, may make the program unattractive to some providers, potentially lowering program-wide savings by reducing participation. The involvement of providers with high spending that isn’t explained by patient risk factors is particularly critical to MSSP success, because the care their patients receive (including care from other providers) presents the greatest opportunities for savings. So far, ACOs with high risk-adjusted spending have lowered spending more than ACOs that began with low spending.

Hearty Perennials Of The Affordable Care Act Battles

For several years, supporters of the ACA have attempted to force the Little Sisters of the Poor to provide free-of-charge abortion-inducing contraceptives to their employees under this law. A 2011 HHS mandate requiring employers to provide certain health care, including birth control and emergency contraception, generated a lawsuit by the nuns. They sued in 2013 to be exempt from the rule, but lengthy court battles later, the case still is ongoing. New HHS rules created in 2017 allowed for religious exemptions for employers, including the group run by the Little Sisters of the Poor, but 13 states and the District of Columbia sued to block the rules. Two judges in January temporarily blocked the rules from going into effect, but a hearing presided over by a federal judge in California in June 2019 helps to guarantee that the dispute will continue to be ongoing regardless of any ruling that emerges.

More Articles from TRENDS June 2019


Indicates how formulations, such as paradigms have the potential to blind advocates of various interventions to the actual worth of whatever is being proposed. Read More


Gwendolyn Mahon from Rutgers University is featured in this issue of TRENDS. Read More



Discusses efforts to meet health challenges in rural areas, savings from Accountable Care Organizations, and a hearty perennial of the Affordable Care Act disputes. Read More



Summarizes renewed efforts to reauthorize the Higher Education Act, launch of a Federal Work-Study Experiment, and proposed federal rules affecting accreditation, innovation, and other topics. Read More


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  • Financial Burden Of Paid Home Care On Older Adults

  • Faith-Health Collaboration To Improve Community And Population Health

  • Family Care-Giving Roles In Medical Product Development

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Mentions the 2nd Annual ASAHP Summit co-hosted by Kindred Healthcare and Saint Louis University’s Doisy College of Health Sciences that was conducted on May 31, 2019 at Saint Louis University in St. Louis, MO. Read More



Refers to the use of AI to address the issue of ‘bounded rationality” in the context of antibiotic prescribing and antimicrobial resistance. Read More