Providing longer duration inpatient hospital care (in excess of 25 days on average) to individuals with complex medical conditions, long-term care hospitals (LTCHs) are an important part of the national hospital infrastructure that serves over 62 million Americans with Medicare long-term care coverage. In the calendar year 2020, the Medicare program counted among its participating providers 347 LTCHs that had more than 23,700 total beds. Here is a regional breakdown of Medicare's long-term care hospital bed capacity (to see state-level data, follow the "region" links in the table below):
Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
Heart disease accounted for almost 697,000 deaths in the U.S. in 2020. making it the nation's leading cause of death. In the four-state Southwestern U.S., there were more than 80,400 heart disease deaths that year. Consistent with a pattern seen nationally, the heart disease death rate for women in the region was lower than it was for men. That said, in 2020 the heart disease death rate in the Southwestern U.S. for each gender was below the national average for the respective gender. That result was consistent with the fact that in 2020 the Southwestern U.S. had the nation's third-lowest regional heart disease death rate. A closer examination of federal government statistical data reveals the following about male vs. female heart disease death rates in the Southwestern U.S.:
Male vs. Female Heart Disease Death Rates in the Southwestern U.S.
Deaths
Population
Death Rate*
Regionwide
80,454
42,869,262
187.7
Male
45,507
21,280,617
213.8
Female
34,947
21,588,645
161.9
Nationwide
696,962
329,484,123
211.5
Male
382,776
162,256,202
235.9
Female
314,186
167,227,921
187.9
(*) number of heart disease deaths per 100,000 population
Report Period: 2020
States in Region: Arizona, New Mexico, Oklahoma, and Texas
Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on March 25, 2023
In the five-state Rocky Mountain region of the U.S., drug-induced causes, mostly overdoses, accounted for 2,765 deaths in 2020. Relative to population size, at 22.0 deaths per 100,000 population, the drug-induced death rate in the region was almost 25% below the national average. Statistically, this gave the Rocky Mountain region the third-lowest regional drug-induced death rate in the U.S. in 2020. In a pattern seen elsewhere in the U.S., the drug-induced death rate in the region's largest urban population centers ran noticeably higher than in its smaller metro and rural populations. This is in contrast to the all-cause death rate, which typically runs lower in larger metro areas than in smaller metro and rural populations. A deeper dive into data from the CDC's National Center for Health Statistics (NCHS) reveals the following details about urban vs. rural drug-induced death rates in the Rocky Mountain region:
Urban vs. Rural Drug-Induced Death Rates in the Rocky Mountain Region
County Classification
Deaths
Population
Death Rate*
Large Central Metro
586
1,901,055
30.8
Large Fringe Metro
532
2,330,205
22.8
Medium Metro
818
3,900,314
21.0
Small Metro
356
1,669,221
21.3
Micropolitan (Nonmetro)
262
1,616,653
16.2
NonCore (Nonmetro)
211
1,129,968
18.7
Region
2,765
12,547,416
22.0
Nationally
96,096
329,484,123
29.2
(*) number of drug-induced deaths per 100,000 population
Report Period: 2020
States in region: Colorado, Idaho, Montana, Utah, and Wyoming
Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on March 25, 2023
Serving the inpatient rehabilitation care needs of over 62 million Americans having Medicare Part A insurance coverage, rehabilitation hospitals are an important part of Medicare's institutional provider network. As of 2020, there were over 310 rehabilitation hospitals, with over 19,400 beds, that were participating in the Medicare program. Here is a breakdown of Medicare rehabilitation hospital beds by region (to see state-level data, follow the "region" links in the table below):
Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
End of Covid Emergency Will Usher in Changes Across the US Health System
Rachana Pradhan
The Biden administration’s decision to end the covid-19 public health emergency in May will institute sweeping changes across the healthcare system that go far beyond many people having to pay more for covid tests.
In response to the pandemic, the federal government in 2020 suspended many of its rules on how care is delivered. That transformed essentially every corner of American health care — from hospitals and nursing homes to public health and treatment for people recovering from addiction.
Now, as the government prepares to reverse some of those steps, here’s a glimpse at ways patients will be affected:
Training Rules for Nursing Home Staff Get Stricter
The end of the emergency means nursing homes will have to meet higher standards for training workers.
Advocates for nursing home residents are eager to see the old, tougher training requirements reinstated, but the industry says that move could worsen staffing shortages plaguing facilities nationwide.
In the early days of the pandemic, to help nursing homes function under the virus’s onslaught, the federal government relaxed training requirements. The Centers for Medicare & Medicaid Services instituted a national policy saying nursing homes needn’t follow regulations requiring nurse aides to undergo at least 75 hours of state-approved training. Normally, a nursing home couldn’t employ aides for more than four months unless they met those requirements.
Last year, CMS decided the relaxed training rules would no longer apply nationwide, but states and facilities could ask for permission to be held to the lower standards. As of March, 17 states had such exemptions, according to CMS — Georgia, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, and Washington — as did 356 individual nursing homes in Arizona, California, Delaware, Florida, Illinois, Iowa, Kansas, Kentucky, Michigan, Nebraska, New Hampshire, North Carolina, Ohio, Oregon, Virginia, Wisconsin, and Washington, D.C.
Nurse aides often provide the most direct and labor-intensive care for residents, including bathing and other hygiene-related tasks, feeding, monitoring vital signs, and keeping rooms clean. Research has shown that nursing homes with staffing instability maintain a lower quality of care.
Advocates for nursing home residents are pleased the training exceptions will end but fear that the quality of care could nevertheless deteriorate. That’s because CMS has signaled that, after the looser standards expire, some of the hours that nurse aides logged during the pandemic could count toward their 75 hours of required training. On-the-job experience, however, is not necessarily a sound substitute for the training workers missed, advocates argue.
Adequate training of aides is crucial so “they know what they’re doing before they provide care, for their own good as well as for the residents,” said Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy.
The American Health Care Association, the largest nursing home lobbying group, released a December survey finding that roughly 4 in 5 facilities were dealing with moderate to high levels of staff shortages.
Treatment Threatened for People Recovering From Addiction
A looming rollback of broader access to buprenorphine, an important medication for people in recovery from opioid addiction, is alarming patients and doctors.
During the public health emergency, the Drug Enforcement Administration said providers could prescribe certain controlled substances virtually or over the phone without first conducting an in-person medical evaluation. One of those drugs, buprenorphine, is an opioid that can prevent debilitating withdrawal symptoms for people trying to recover from addiction to other opioids. Research has shown using it more than halves the risk of overdose.
Amid a national epidemic of opioid addiction, if the expanded policy for buprenorphine ends, “thousands of people are going to die,” said Ryan Hampton, an activist who is in recovery.
The DEA in late February proposed regulations that would partly roll back the prescribing of controlled substances through telemedicine. A clinician could use telemedicine to order an initial 30-day supply of medications such as buprenorphine, Ambien, Valium, and Xanax, but patients would need an in-person evaluation to get a refill.
For another group of drugs, including Adderall, Ritalin, and oxycodone, the DEA proposal would institute tighter controls. Patients seeking those medications would need to see a doctor in person for an initial prescription.
David Herzberg, a historian of drugs at the University at Buffalo, said the DEA’s approach reflects a fundamental challenge in developing drug policy: meeting the needs of people who rely on a drug that can be abused without making that drug too readily available to others.
The DEA, he added, is “clearly seriously wrestling with this problem.”
Hospitals Return to Normal, Somewhat
During the pandemic, CMS has tried to limit problems that could arise if there weren’t enough health care workers to treat patients — especially before there were covid vaccines when workers were at greater risk of getting sick.
For example, CMS allowed hospitals to make broader use of nurse practitioners and physician assistants when caring for Medicare patients. And new physicians not yet credentialed to work at a particular hospital — for example, because governing bodies lacked time to conduct their reviews — could nonetheless practice there.
Other changes during the public health emergency were meant to shore up hospital capacity. Critical access hospitals, small hospitals located in rural areas, didn’t have to comply with federal rules for Medicare stating they were limited to 25 inpatient beds and patients’ stays could not exceed 96 hours, on average.
Once the emergency ends, those exceptions will disappear.
Hospitals are trying to persuade federal officials to maintain multiple covid-era policies beyond the emergency or work with Congress to change the law.
Surveillance of Infectious Diseases Splinters
The way state and local public health departments monitor the spread of disease will change after the emergency ends, because the Department of Health and Human Services won’t be able to require labs to report covid testing data.
Without a uniform, federal requirement, how states and counties track the spread of the coronavirus will vary. In addition, though hospitals will still provide covid data to the federal government, they may do so less frequently.
Public health departments are still getting their arms around the scope of the changes, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.
In some ways, the end of the emergency provides public health officials an opportunity to rethink covid surveillance. Compared with the pandemic’s early days, when at-home tests were unavailable and people relied heavily on labs to determine whether they were infected, testing data from labs now reveals less about how the virus is spreading.
Public health officials don’t think “getting all test results from all lab tests is potentially the right strategy anymore,” Hamilton said. Flu surveillance provides a potential alternative model: For influenza, public health departments seek test results from a sampling of labs.
“We’re still trying to work out what’s the best, consistent strategy. And I don’t think we have that yet,” Hamilton said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Equipped and staffed to give skilled nursing care on a daily basis, Skilled Nursing Facilities (SNFs) serve the needs of over 62 million Americans with Medicare Part A SNF coverage. More than 15,000 skilled nursing facilities, having over 1.58 million beds, participated in the Medicare program in the calendar year 2020. Here is a more detailed look at Medicare skilled nursing facility beds by region (to see state-level data, follow the "region" links in the table below):
Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020.
Nearly 697,000 deaths in the United States in 2020 were attributable to heart disease. In the Mid-Eastern region of the country, which encompasses the District of Columbia and five states, heart disease accounted for 117,371 fatalities in 2020. At 240.7 deaths per 100,000 population, the Mid-East had the second-highest regional heart disease death rate in the country in 2020. In line with a national pattern, the heart disease death rate for females in the region was noticeably lower than it was for males. That said, the heart disease death rate for both men and women in the region was considerably higher than the national average for their respective genders. Further examination of data from the National Center for Health Statistics provides the following details about male vs. female heart disease death rates in the Mid-Eastern U.S.:
Male vs. Female Heart Disease Death Rates in the Mid-Eastern U.S.
Deaths
Population
Death Rate*
Regionwide
117,371
48,757,828
240.7
Male
61,361
23,747,834
258.4
Female
56,010
25,009,994
224.0
Nationwide
696,962
329,484,123
211.5
Male
382,776
162,256,202
235.9
Female
314,186
167,227,921
187.9
(*) number of heart disease deaths per 100,000 population
Report Period: 2020
States in Region: Delaware, Maryland, New Jersey, New York, Pennsylvania, and the District of Columbia
Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on March 24, 2023
In 2020 there were nearly 13,700 deaths in the six-state Far Western U.S. region that were attributable to drug-induced causes. Relative to the size of its population, at 24.2 death per 100,000 population, the drug-induced death rate in the Far West was about 17% below the national average in 2020. In most parts of the country, the drug-induced death rate tends to run materially higher in larger urban areas as compared to more rural populations. That was not the case in the Far Western states as the death rate from drug-related incidents was very similar across all urban and rural population classes in the region. A closer examination of data from the National Center for Health Statistics (NCHS) provides the following details about urban vs. rural drug-induced death rates in the Far Western U.S.:
Urban vs. Rural Drug-Induced Death Rates in the Far Western U.S.
County Classification
Deaths
Population
Death Rate*
Large Central Metro
7,312
30,332,613
24.1
Large Fringe Metro
1,965
8,675,719
22.6
Medium Metro
2,826
11,295,695
25.0
Small Metro
771
3,184,983
24.2
Micropolitan (Nonmetro)
642
2,325,131
27.6
NonCore (Nonmetro)
181
756,133
23.9
Region
13,697
56,570,274
24.2
Nationally
96,096
329,484,123
29.2
(*) number of drug-induced deaths per 100,000 population
Report Period: 2020
States in region: Alaska, California, Hawaii, Nevada, Oregon, and Washington
Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on March 23, 2023
Serving more than 62 million Americans having Medicare Part A insurance coverage, psychiatric hospitals are an important part of Medicare's provider network. As of 2020, there were over 600 psychiatric hospitals, with more than 61,000 beds, that were participating in the Medicare program. Here is a breakdown of Medicare psychiatric hospital beds by region (to see state-level data, follow the "region" links in the table below):
Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
Providing acute inpatient care, short-stay hospitals are the foundation of the hospital infrastructure serving over 62 million Americans with Medicare Part A insurance coverage. In the calendar year 2020, across the country there were more than 3,400 short-stay hospitals, with over 774,000 beds, that participated in the Medicare program. Here is a more detailed look at Medicare short-stay hospital beds by region (to see state-level data, follow the "region" links in the table below):
Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
In the seven-state Great Plains region, drug-induced deaths, mostly attributable to overdoses, accounted for 4,542 deaths in 2020. Relative to population size, the drug-induced death rate of 21.1 deaths per 100,000 population in the region was nearly 28% lower than the national average. This gave the Great Plains the second-lowest regional drug-induced death rate in 2020. There was, however, a very wide disparity in the drug-induced death rates between urban and rural populations in the region, with death rates in smaller communities and rural areas being much lower than in larger urban areas. Despite the region having an overall low drug-induced death rate in comparison to the nation as a whole, large central metro areas in the region collectively had a higher drug-induced death rate than the national average. Further study of data from the CDC's National Center for Health Statistics (NCHS) yields the following details about urban vs. rural drug-induced death rates in the Great Plains region:
Urban vs. Rural Drug-Induced Death Rates in the Great Plains Region
County Classification
Deaths
Population
Death Rate*
Large Central Metro
1,008
2,819,881
35.7
Large Fringe Metro
1,247
5,016,579
24.9
Medium Metro
788
3,793,143
20.8
Small Metro
528
3,430,748
15.4
Micropolitan (Nonmetro)
515
3,140,344
16.4
NonCore (Nonmetro)
456
3,281,139
13.9
Region
4,542
21,481,834
21.1
Nationally
96,096
329,484,123
29.2
(*) number of drug-induced deaths per 100,000 population
Report Period: 2020
States in region: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota
Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on March 18, 2023
Rehabilitation hospitals comprise part of the hospital network that serves the needs of over 62 million Americans with Medicare Part A insurance coverage. Over 6,200 hospitals of various types, with more than 927,000 beds in the aggregate, were participating in the Medicare program as of the calendar year 2020. Rehabilitation hospitals made up about 5% of those hospitals and accounted for just over 2% of those hospital beds.
In the calendar year 2020, the four-state Southwest region of the U.S. was home to 84 rehabilitation hospitals, with about 4,600 beds, that were participating in the Medicare program. As such, the Southwest region was home to about 11% of the nation's Medicare Part A enrollees and 24% of the program's rehabilitation hospital beds. Here is a state-level summary look at Medicare rehabilitation hospital beds in the Southwest region of the U.S.:
Medicare Rehabilitation Hospital Beds in the Southwest
Area
# Part A Enrollees
# Hospitals
# Beds
AZ
1,359,840
12
666
NM
427,346
4
222
OK
753,140
4
182
TX
4,275,461
64
3,531
Region
6,815,787
84
4,601
National*
62,498,751
314
19,481
% of National
10.9%
26.8%
23.6%
* National totals include U.S. territories
Data Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
Skilled Nursing Facilities (SNFs) provide services to more than 62 million Americans with Medicare Part A SNF coverage. SNFs are institutional medical providers staffed and equipped to give skilled nursing care on a daily basis. Skilled nursing facilities, in most cases, can also provide skilled rehabilitative care and certain other related services. More than 15,000 skilled nursing facilities, having over 1.58 million beds, were participating in the Medicare program as of the calendar year 2020.
In the calendar year 2020, the twelve-state Southeastern U.S. was home to 3,560 skilled nursing facilities, having over 390,000 beds, that were participating in the Medicare program. Although home to 24.6% of Medicare's SNF beds, about 27.3% of the nation's Medicare Part A enrollees lived in the region. Thus, Medicare enrollees in the region were modestly under-served by SNF beds relative to enrollees in many other parts of the country. Here is a summary look at Medicare skilled nursing facility beds in the Southeast:
Medicare Skilled Nursing Facility Beds in the Southeast
Area
# Part A Enrollees
# SNFs
# Beds
AL
1,056,359
226
26,607
AR
645,494
221
23,719
FL
4,674,019
704
84,250
GA
1,754,062
355
38,471
KY
931,126
284
26,612
LA
882,812
276
33,799
MS
609,478
183
16,547
NC
2,028,204
426
43,928
SC
1,101,105
189
20,029
TN
1,382,574
308
35,076
VA
1,540,473
274
31,313
WV
442,495
114
9,881
Region
17,048,200
3,560
390,232
National*
62,498,751
15,015
1,588,755
% of National
27.3%
23.7%
24.6%
* National totals include U.S. territories
Data Source: CMS Program Statistics, Table: MDCR PROVIDERS 4. Medicare Providers: Number of Medicare Certified Hospitals and Skilled Nursing Facilities, and Number of Beds, by State, Territories, Possessions, and Other, the Calendar Year 2020
