What Constitutes a Frontier and Remote (FAR) Area?

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The day of reckoning for rural healthcare is almost here, and framing it as a “day of reckoning” is only a mild exaggeration. According to John Commins over at HealthLeaders Media, rural healthcare providers have yet another issue that requires their immediate engagement–the federal definition of what a rural and frontier area is.

The Department of Health and Human Services (HHS) is giving rural providers until Jan. 7, 2013, to publicly “comment on the methodology used to determine what exactly constitutes a Frontier and Remote (FAR) area,” Commins writes.

The problem is, the six-page document from HHS is filled with “dust-dry verbiage” and “utterly arcane wonkery” that dares to confuse even the most astute of providers.

The following is just an example:

“Using data from the Census Bureau, every census tract in the United States is assigned a (Rural-Urban Commuting Area) code. Codes range from 1 through 10, with 23 sub codes, with code 1 representing the most densely populated urban areas and code 10 representing rural areas with primary commuting to a tract outside an Urbanized Area or Cluster.”

No matter how “dust dry” it is, Commins warns that “…it could be a very big deal to rural communities. The dry methodology that is eventually adopted will be used to determine appropriate levels of federal funding and grants for rural healthcare providers.”

Susan Wilger, director of programs for the National Center for Frontier Communities (NCFC), is pleading with rural providers and anyone else who could be impacted by the HHS’ eventual ruling to ask the following questions about the definition and content of the six-page document: “Is the definition appropriate? Does it need to be fixed?”

Wilger has not ruled out that the definition could be a good one. However, she has several concerns, including a conceptual concern.

“How is this consistent with existing definitions to frontier?” she asks. “Is this going to be a dramatic change that could have implications if certain federal agencies adopt this definition?”

Another concern is the methodology HHS has used to arrive at its FAR definition. Apparently, the definition is based not on 2010 census data, but on 2000 census data. Also baffling is its failure to include data from all 50 states, with Alaska and Hawaii, along with large swaths of New Mexico, absent.

“We wonder how often the data sets are going to be refreshed,” she said, stressing this is why it is important that they receive feedback from rural providers around the country. “We don’t want to water down the few resources that are available to rural, frontier, and very remote healthcare service providers. They are already dealing with really sparse resources and unique challenges.”

Rural providers who are interested in reading the report can find it here.

Feedback can be given to Wilger’s group, located here. The National Rural Health Association and the National Organization for State Offices of Rural Health is also asking for rural providers’ input on the definition. Finally, keep an eye out for a webinar that will be held on this matter by these three organizations in December.

-by Pete Fernbaugh

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