Wednesday, October 1, 2014

10/01/2014 at 12:07pm

Source: Centers for Medicare & Medicaid Services

Crawford Memorial Hospital, in rural Robinson, Ill., is the only hospital for miles around.

Just like elsewhere, Crawford’s doctors deliver babies, perform routine operations and see thousands of patients in the emergency room.

But Crawford, along with one-quarter of the hospitals around the country, is being left out of some of the biggest shifts in American health care initiated by the Affordable Care Act. These changes are aimed at bringing accountability to hospitals by linking Medicare payments to the quality of their care. They also are encouraging hospitals to monitor patients’ health so doctors and nurses can intervene before problems become acute.

The Department of Health and Human Services has not yet incorporated the 1,256 primarily rural, “critical access” hospitals such as Crawford into Medicare’s pay-for-performance programs. With no more than 25 beds, these hospitals are generally located in isolated areas, making them the only acute-care option for local residents. Medicare repays them their cost plus 1 percent, more than it pays other hospitals, to ensure they do not close.

While some of the facilities deliver exemplary care, a study published last year by Harvard School of Public Health researchers found that death rates at critical access hospitals in 2010 were higher than at other small, rural hospitals and the industry overall.

The health law required the government to start testing how to provide bonuses and penalties to critical access hospitals based on their quality by 2012. But Congress never provided any money.

Other Medicare efforts to improve care also are not making major inroads among rural hospitals.

Fewer than 1 in 20 critical access hospitals are participating in accountable care organizations, or ACOs, in which hospitals and doctors coordinate services with the promise of bonuses from Medicare if they deliver care more efficiently. Another project, to test new ways to deliver rural health care, is limited to five states, and the selection of participants has not been announced even though the deadline for applications was in May.

10/01/2014 at 4:38am

Photo by Alden Jewell Greyhound's annual ridership peaked around 130 million about the time this 1971 Scenicruiser was manufactured. Though many of Greyhound’s rural stops have been discontinued in recent decades, Meriwether O’Connor’s trip is reminiscent of an age when the bus line was synonymous with small-town America.

EDITOR’S NOTE: Writer, columnist and small-farmer Meriwether O’Connor of Maine is embarking on a book tour to promote her new collection of short stories, Joe Potato's Real Life Recipes: Tall Tales and Short Stories. Our interest was piqued when we learned that the author, who has rural Texas and Kentucky roots, planned to conduct her multi-state tour via Greyhound bus. She’ll leave the driving to the professionals (as the characters in her book do) and enjoy the company of her fellow passengers. She hopes to share copies of her book with other riders, in return for hearing some of their stories.

We asked Meriwether to take Daily Yonder readers along for the ride from Maine to (she hopes) Texas. In this article, Meriwhether shares a bit about the purpose and logistics of her trip. Then she provides a long-distance bus-rider’s to do list, which we hope will be of some practical value to Yonder readers, especially those of you who still enjoy packing your own food for a long journey.

But first, we asked Meriwether to explain why she was riding a bus on a multi-state book tour. Don’t authors usually prefer jets and limousines? Here’s her response.


Greyhound is cost effective for me, it's what the characters in my short stories do, and it's a chance to get the book to, and hear stories from, folks who would probably not go to a reading.

On my last Greyhound trip to New York City this spring, I had a seatmate give me her extra paperbacks. So I thought it might be fun to do the same, but sort of with a twist – bringing my own book to the audience vs. the other way around. (That time I was seeing friends and also researching what weeds grow on the city streets there so my characters would be accurate when they described the foraging for food they did there.)

This trip is much longer. I'm visiting people along the way, and I’ve also passed out my itinerary to others so if anyone wants to come to the station and say hey, they can when I pass through their state. Some of my Texas plans fell through due to illness, so I'm still considering what to do. I'll be in Western Kentucky until October 7 or 8, then looking for stuff to do from there until October 11 or 12 when I need to head back. Should I still go to Texas, head to another state, stay in Kentucky? I can only afford to have livestock taken care of for so long back home.

One story in the book features a woman who takes the Greyhound bus to the city to gallivant around and the drifter who sets up camp in her place while she's gone. Oh, and it also has a recipe for how to make an old fashioned applehead doll, if you in fact needed to know how to do that.

09/30/2014 at 12:30pm

Photo by Ryan Henriksen for the New York Times Signs in support of the diverse opposition to the Keystone XL Pipeline project hang at the Harvest the Hope concert in Neligh, Nebraska.

With a coalition of farmers, ranchers, Native Americans and urban environmentalists, Nebraska has become the center of opposition to the Keystone XL project. One farmer, Art Tanderup, recently hosted a concert, Farm Aid-style, on his ranch to raise funds to fight the proposed pipeline, which would carry heavy tar-sands oil from Canada to the Gulf of Mexico.

“I’ve told them, ‘You’ll have to haul me out from in front of that bulldozer, because I’m going to protect this farm,’ ” said Tanderup…Their land in the rolling hills of northeast Nebraska would be directly along the pipeline route.”

Around 8,000 people showed up for the concert, called Harvest the Hope, which featured Willie Nelson and ol’ Neil Young.


Minneapolis-based photographer Alec Soth dreamed up a small town newspaper and convinced a writer friend to tag along on road trips to find stories for each issue. The paper didn’t stay a dream for long. Soth and his writer friend started publishing these papers as special edition broadsheets. The latest issue, Georgia, is the last of the series. It’s a shame, because the photos are diverse, odd, and beautiful in a way that few actual have time to produce.


There’s a battle in South Dakota, as well as the rest of the nation, against consolidated school in rural school districts, but small schools continue to close. The merging of several small schools to make a larger one makes financial sense, but what’s often lost is the feeling of family that comes with attending school in a close-knit community.

“Our kids are being punished because of where they live,” said Robert Mahaffey, communications director at the Rural School and Community Trust. “They think, ‘It’s only six kids. It doesn’t matter if we close the school,’ but it’s a huge impact.”

09/30/2014 at 6:55am

The decline of newspapers has made many headlines in recent years.  Lower revenue, declining readership, and increasing competition from a variety of online sources have led many to believe that traditional newspapers are on their way out

Some recent survey results from Oklahoma, however, make clear that rural residents still highly value their local newspapers. 

In fact, when residents of 12 rural communities were asked about their current (and preferred) way of receiving information on local community events, respondents selected newspapers over social media or email by an overwhelming margin.  This pattern held regardless of whether the surveys were paper-based or collected online. 

Thus, even in this age of endless Facebook feeds and dizzying arrays of other social media options, the good ol’ newspaper still has a beloved place in many rural residents’ hearts.  This is important for many businesses, nonprofits, clubs, governments and social networks that might be interested in promoting an event in a rural community. That’s not to say that new media isn’t part of the rural communication equation, as well. The second most preferred method of receiving information was social media.

A Little Background

Previous research has found that since 2001 there has been a notable increase in online media, while offline media such as newspapers experienced sizable declines.  Businesses and people working in rural communities are left grappling with how to best inform the local community about future events and programs. 

To answer these questions, we turn to a survey distributed as part of the Community Health Needs Assessment (CHNA) program in Oklahoma.  CHNAs allow communities to gather valuable information about their community and the needs of their residents.  Completing a CHNA is a new requirement for non-profit 501(c)(3) hospitals that submit IRS Schedule H Form 990 – implying that all non-profit hospitals must complete the process every three years. Most of the facilities that participate are critical access hospitals, which, by definition, are small facilities located in rural communities.

09/29/2014 at 7:44am

Police point their guns at an unarmed citizen in Ferguson, Missouri, during the aftermath the shooting of Michael Brown.

Missouri has been in the news, so I suppose it’s natural for folks to ask me about events in Ferguson. The first thing to know is that Langdon is about as far as you can get from that St. Louis suburb and still remain in Missouri.  Go any father, and you’re in Iowa or Nebraska.

We’re in the same state, but it’s different. Take for example, the composition of the people who live here.

All my ancestors traveled to northwest Missouri one by one, escaping Irish potato fields or the German empire.

One great-great grandfather, an Irishman named Casey, as family legend has it, helped escaping slaves get on up the road north 30 miles to Nebraska City, Nebraska. History recalls it as John Brown’s underground railway.

The place where it happened, grandfather’s house, still stands a mile or so from mine.

Of course, I wasn't around in great-great grandpa’s day. I never got to see it. So, near as I can remember, the first African American I saw in real life was a porter standing in the doorway of the Burlington Zephyr passenger train passing through Langdon station on its way to Omaha.

And in the ’50s and early ’60s, Gypsies came through once or twice a year, sometimes camping south of town. They sure seemed different.

That sums up the diverse racial and ethnic experience of a north Missouri farm boy.

09/26/2014 at 7:37am
NYC to USA The K.K. Fiske Restaurant on Washington Island, Wisconsin, serves "fresh lawyers" -- a fish that got the nickname because of its small heart, according to the blog NYC to USA. The island in Lake Michigan has only 718 year-round residents, but it has a medical clinic, thanks to the “place-based” and “people-centered” policies of Ministry Door County Medical Center.

A lot of people write about the future of rural health care. Typically there is no shortage of anxiety on the topic. But there is more to the story. We need to understand that rural can be health care’s future.

I know better than most the list of challenges for rural communities. I don’t deny them, but it pays also to look at what we do well and how rural health care can help lead American health care.

Rural health care is part of the change sweeping across the country. The mandate has rightly become to drive quality of care up and costs down while improving the health of the whole community. Rural is and will be part of that “Triple Aim” movement.

The best of rural health has long focused on places and patients. “Place-based” care means that health organizations consider the values, tradition and economic well being of the community when they make decisions. “Patient-centered” care means that we organize the health-care experience around the needs of the patient as opposed to just the convenience of the provider.

One great example of place-based, patient-centered care is the work of Ministry Door County Medical Center based in Sturgeon Bay, Wisconsin. They subsidize a clinic in partnership with the 718 year-round residents of Washington Island in Lake Michigan. That wouldn’t happen if the medical center didn’t value places and patients.

These values are deeply embedded in rural health and will be a key driver of success for health care in both rural and urban communities. We do not need to turn rural into a small version or outpost of urban. We do need to build on our natural strengths as we continue to evolve our services to meet the Triple Aim.

09/25/2014 at 3:33pm

Photo by Daniel Rosenbaum / The New York Times FCC chairman Tom Wheeler has proposed using “Title II” of the Communications Act to justify the FCC regulating the internet like they a phone company.

The Federal Communications Commission has received a record-breaking 3.7 million comments about net neutrality. But a group of rural broadband advocates hopes the commission gets a few more responses – from members of Congress.

The Rural Broadband Policy Group is asking members of Congress to weigh in on the FCC’s decision over net neutrality – a principle that requires Internet companies to treat all traffic the same and not allow some data to move to the front of the line.

The FCC is considering a proposal to enforce net neutrality. Rural advocates say the proposal doesn’t go far enough to protect small and independent content producers from bad treatment from major Internet service providers like Comcast, Verizon and AT&T.

“On the Internet, rural [content providers] are currently treated the same as the most powerful and wealthy, and rural ideas reach the same audiences that the most powerful and wealthy reach,” said Edyael Casaperalta, coordinator of the National Rural Assembly’s broadband working group and a fellow at the Washington D.C.-based nonprofit Public Knowledge. “But some providers want to sell a sort of VIP pass to wealthy content providers, leaving others who produce information stuck in the slow lane. And that’s more likely to be rural content providers.”