Key House panel chairman claims EPA encourages lawsuits to avoid normal rulemaking process

The chairman of the House Subcommittee on Energy and the Environment charged Thursday that the Environmental Protection Agency is colluding with environmental groups to avoid the usual process for adopting regulations. Rep. Ed Whitfield of Kentucky's 1st District, left, said "We have reason to believe" that EPA encourages lawsuits against some aspect of a proposed rule, then settles with the plaitiffs and pays their legal fees.

"It is a path devoid of both messy public comment periods and political accusations over whether EPA is moving unilaterally," John McCardle of Greenwire writes for The New York Times. "Whitfield's charges aren't exactly new," he notes, but writes that the hearing before the Energy and Commerce Committee "was one of the most public -- and vociferous -- airings of the theory in many months."

Environmental groups said Whitfield was off base, but the congressman, whose district includes most of the Tennessee Valley Authority's service area in Kentucky, said another version of the technique probably played a role in TVA's settlement with environmental groups over the federal utility's alleged air-pollution violations. "EPA had to sign off on the April settlement," Greenwire notes. (Read more)

Delta plans to drop service to 24 small airports; could be a blow to federal subsidy program

UPDATE, July 16: Subsidies for 13 rural airports within a 90-mile radius of other airports would be cut, under a Senate plan that key House Republicans have decided to adopt, Bloomberg News reports.

Delta Air Lines announced today that it plans to longer serve 24 airports, most of them in rural areas that earned the company a federal subsidy for providing service. Delta said it would be willing to continue service to nine of the cities if the Essential Air Service subsidy is increased. (Photo by Mark Lawrence: Delta regional turboprop, type of aircraft used to serve many such airports)

"Delta and its regional partners are required to continue to serve the communities until the U.S. Department of Transportation can find a replacement carrier and funds it," Kelly Yamanouchi of the Atlanta Journal-Constitution reports.

"Delta said it has given the U.S. Department of Transportation 90 days to find replacement carriers for the subsidized routes, in some cases working with other airlines to bid on the services," Matt Molnar of NYC Aviation reports, listing the 24 cities. The nine for which it is seeking higher subsidies are in the Midwest and Northern Plains, Doug Cameron and Mia Lamar of Dow Jones Newswires report.

They write that Delta's move "could prove a severe blow to the system of federal subsidies for loss-making routes carrying just a handful of passengers per flight. . . . The EAS budget rose to more than $200 million last year supporting flights that carried a little over 100,000 passengers, making it a target for federal budget cutters and other critics who see the system as flawed."

The story notes that some flights have no passengers, and the two flights per day at Thief River Falls in northwest Minnesota each have four. Other cities with "load factors" of less than 45 percent on the list include Greenville, Miss.; Devils Lake, N.D.; Watertown, S.D.; Muscle Shoals, Ala.; Fort Dodge, Iowa; Hibbing, Minn.; Alpena, Mich.; Tupelo, Miss.; and Jamestown, N.D.

Garry Barker dies; promoted crafts, wrote books and columns, and published a newspaper

Funeral services were held today in Flemingsburg, Ky., for Garry Barker, a Kentucky author, newspaper columnist and former publisher of the weekly Flemingsburg Gazette. He suffered from emphysema and died Tuesday at the age of 67. Barker and his wife Danetta sold the Gazette to Chris McGehee of Brandenburg this spring after owning it for almost five years.

Barker, a graduate of Berea College, worked in Berea as an arts administrator for the Kentucky Guild of Artists and Craftsmen and Berea College Crafts, and was director of the Kentucky Folk Art Center in Morehead. He published 15 fiction and non-fiction books, including short-story collections Fire on the Mountain and Kentucky Waltz, and was known for his weekly column, "Head of the Holler," which appeared in several Kentucky papers. (Read more)

Baltimore Sun columnist John McIntyre, who started his career at the Gazette, wrote of Barker: "Though what fame he achieved was local, and some of his columns betrayed the marks of haste, he was a writer working tirelessly over the years to achieve on his terms what he had seen writers like Jesse Stuart and Harry Caudill and Wendell Berry accomplish: to give a voice and dignity to the people of his region. His work is done, and it was honorable." (Read more)

Bailouts worked, and made money for taxpayers

Shadowing the debate over raising the limit on the national debt is a populist suspicion that Congress is a tool of Wall Street, and the most-cited evidence of that is the 2008-09 bailout of the financial system. "You hear over and over that the bailout was a disaster, it cost taxpayers a fortune, we didn’t really need it, it didn’t work, it was a failure. It has become politically toxic, which inhibits reasoned public discussion about it," Allan Sloan writes for The Washington Post.

"But you know what? The bailout, by the numbers, clearly did work. Not only did it forestall a worldwide financial meltdown, but a Fortune analysis shows that U.S. taxpayers are also coming out ahead on it — by at least $40 billion, and possibly by as much as $100 billion eventually. This is our count for the entire bailout, not just the 3 percent represented by the massively unpopular Troubled Assets Relief Program. Yes, that’s right — TARP is only 3 percent of the bailout, even though it gets 97 percent of the attention."

Sloan goes on to explain the various bailouts, without which "There would have been trillions of dollars in losses, worldwide panic, missed payrolls and quite likely the onset of the Great Depression II." He also delivers what he said is the first accounting of the $35 billion tax expense of "special IRS rulings that allowed TARP recipients AIG, Citigroup, General Motors and Ally Financial (formerly GMAC) to use their tax losses in full, rather than being subject to 'change in control' rules designed to stop companies from being taken over for their tax losses."

It's those kinds of favors, and that kind of complexity, and those kinds of numbers, that make a lot of people grind their teeth and jump to conclusions about the bailouts, which began in the Bush administration and were continued by the Obama administration. Journalists should help Amercians distinguish between myth and fact. Now that the full story can be told, and we have it from such a reliable sources as Fortune magazine and Allan Sloan, it's a piece that is worth republishing, or at least excerpting and linking. Read it here.

Southeast Regional Rural Education Summit to be held in Nashville Tuesday and Wednesday

The Southeast Regional Rural Education Summit will be held at Lipscomb University in Nashville July 19 and 20. Orgaizers say it will be a unique event bringing together nearly 500 educators, administrators, policymakers, and community leaders from communities throughout the region to focus on education strategies as the key to improving rural economic development.

The lead partner for the event is Tennessee SCORE (State Collaborative on Reforming Education), a nonprofit founded by former U.S. Sen. Bill Frist. Other partners include the Rural School and Community Trust, the Tennessee School Boards Association and the Southern Regional Education Board. For more information on the summit go to http://www.tnscore.org/registration.

House votes to limit EPA power on wetlands, water pollution and mountaintop removal

This week the House of Representatives approved by 239 to 184 the proposed "Clean Water Cooperative Federalism Act of 2011" to give states, instead of the Environmental Protection Agency, final authority over water pollution, wetlands and mountaintop-removal mining. While the bill is not expected to survive in the Democratic-controlled Senate, it was a key vote of choice between environmental and business interests; how did your representative vote?

"This bill is not about whether the members of his body support clean, safe water. We all support clean, safe water," Democratic Rep. Nick Rahall of West Virginia, co-sponsor of the bill, told Paul Quinlan of Environment & Energy Daily. "This bill is about the process and precedent. It's about whether we should be allowing one federal agency to run roughshod over the law, over the states and over other federal agencies to set policy according to political ideology."

But Democratic Rep. Tim Bishop of New York said, "This flies in the face of decades of experience in enforcing the Clean Water Act and risks all of the gains we have made over the last 40 years." Democratic Rep. Jared Polis of Colorado sees this decision as a "gift to the mountaintop-mining and agriculture industries. This is a backdoor handout to a few destructive companies. It's not something that should be discussed in the context of federalism." (Read more, subscription required)

House Appropriations Committee votes to eliminate funding for community police officers

Republicans on the House Appropriations Committee want to eliminate the 17-year-old federal Community Oriented Policing Services (COPS) program that has helped states and localities hire community police officers since 1994, provide no more funding for states to help pay the costs of imprisoning illegal immigrants, and sharply reduce federal juvenile justice funding. It's part of an overall reduction of more than $1 billion in the Justice Department budget of $27 billion-plus that the committee approved yesterday.

Republicans defeated an amendment by Democratic Rep. Chaka Fattah of Pennsylvania to give $35 million to the COPS program. Commerce and Justice Subcommittee Chairman Frank Wolf, R-Va., "said he was supportive of COPS but objected to the offset Fattah came up with – to take money from an asset forfeiture fund also used by law enforcement," Erik Wasson of The Hill reports. Wolf did agree to seek additional funding for the program if more money becomes available. (Read more)

Tennessee professor makes online librarian master's program available in Appalachia

"Residents of rural Appalachia have consistently lower levels of computer ownership, education and access to information than the rest of the nation does," Bharat Mehra, an associate professor in University of Tennessee's School of Information Sciences told Megan Boehnke of the Knoxville News Sentinel. In response, Mehra is empowering rural libraries by offering an online-based rural librarian master's program with an information technology focus.

Mehra, right, applied and received a grant from the Laura Bush 21st Century Library Program following his exploratory study that showed a need for more resources for rural libraries in the region, Boehnke reports. The grant, totalling $567,660, teaches rural librarians how to conduct research online, market their libraries' programming, write grant applications, and create and use databases.

"We live in a very rural community, and Internet here is splotchy," Richard Haynes, director of the Harlan County Public Libraries system in Kentucky, told Boehnke. "We have areas that only have dial-up, and we have very little broadband reach into outlining communities. A lot of people are very dependent on libraries for that."

The Sevier County Public Library System, the Clinch-Powell Regional Library, the Watauga Regional Library and the Nolichucky Regional Library were regional partners in establishing the program. (Read more)

Defenders of small, rural hospitals take issue with study that found poor patient outcomes

A recent study that concluded small, rural "critical access hospitals" have poorer patient outcomes and lower quality of care is making waves in the medical community. A federally funded monitoring team from three universities issued a response noting certain weaknesses of the study, which was published in the Journal of the American Medical Association earlier this month.

It's not news that critical-access hospitals "have room for improvement," the team wrote. "What the JAMA authors fail to report is how much CAH scores on the process of care measures have improved over time. Our most recent trend analysis, for example, shows that CAH scores on each of the pneumonia measures increased between 9 and 22 percentage points between 2005 and 2009."

The analysis in question was performed by researchers at the Harvard School of Public Health. It focused on nearly 1,300 critical access hospitals and looked at the outcomes of Medicare patients who have congestive heart failure, heart attacks and pneumonia. For all three conditions, CAHs performed at a lower standard. Patients at CAHs were more likely to die, and the facilities were behind in implementing electronic health records. It also found CAHs had a smaller number of specialists like cardiologists working at them than at non-CAHs.

"Issues such as the limited supply of primary care providers, home health and hospice services, rather than the supply of specialists, should be the focus of interventions to improve rural health quality," said the Flex Monitoring Team, named after its assignment, to evaluate the Medicare Rural Hospital Flexibility Grant Program. The team is made up of researchers from the University of Southern Maine, the University of Minnesota and the University of North Carolina-Chapel Hill. (Read more)

Writing for the Daily Yonder, Dr. Robert C. Bowman, family-medicine professor at the A.T. Still University School of Osteopathic Medicine in Arizona, also took issue with the study, in part because its findings ran counter to an article that was also published in JAMA last year. That article concluded that "greater proportions of underinsured, minority, and non-English-speaking patients were associated with lower quality rankings for primary-care physicians," Bowman quotes.

"Now JAMA has an article this year claiming lower quality of care in certain types of rural hospitals that are completely different in location, population, funding, and workforce," Bowman writes. "So what happened between last year, when patients made the difference in quality, and this year when it was location of the hospital? ... Why do sophisticated researchers, reviewers, and editors maximize the context of care sometimes (in 2010) and minimize it at other times (in 2011)?"

Bowman, founder of the Rural Medical Educators Group of the National Rural Health Association, took a jab at the researchers. "Do Harvard University researchers associated with hospitals with the most sources of income and the highest reimbursement rates even have the perspective to write about hospitals with the least lines of funding and the lowest reimbursement in each line?"

Though he takes issue with the article, Bowman said the topic "about high and lower quality critical access hospitals" is worthy of research. "Perhaps one of the problems with attempting such research is that there is little variation across rural hospitals. Perhaps that's because the system is designed to spend uniformly less on health care across rural America ... The end result is less care and less economic impact from healthcare in 30,000 zip codes with 65 percent of the U.S. population. And more care delivered in 3,400 zip codes in 4 percent of the land area." (Read more)

AEP pulls plug on project to capture and store carbon dioxide from coal-fired power plant

American Electric Power Co. announced today that it is canceling a federallly funded project to commercialize the technology of capturing and storing carbon dioxide from coal-fired power plants. The announcement is "a major setback to a technology that is seen as key to fighting climate change," Gabriel Nelson of Environment & Energy News reports. "Other plants are being equipped with carbon capture technology, but few projects are as far along or ambitious as AEP's project." (Read more, subscription required)

AEP said in a news release that its work on carbon capture and storage is "on hold" and cited "the current uncertain status of U.S. climate policy and the continued weak economy as contributors to the decision." It said the project at its Mountaineer plant in New Haven, W.Va., had reached a new phase, expanding it to most of the plant's capacity and pumping carbon dioxide underground, and "It is impossible to gain regulatory approval to recover our share of the costs for validating and deploying the technology without federal requirements to reduce greenhouse gas emissions already in place. The uncertainty also makes it difficult to attract partners to help fund the industry’s share." (Read more)

"Utility commissions in West Virginia and Virginia balked at the suggestion of passing the cost of a CCS retrofit through to ratepayers," Jean Chemnick of E&E reports, citing John Coequyt, the Sierra Club's senior climate and energy representative. "The problem is keeping new coal-fired electric generation from being built in states across the country, he said, because regulators are concerned that they will eventually require costly carbon retrofits. . . . He added that AEP might have timed its announcement to come in advance of EPA's proposed power-plant standards," due by Sept. 30. "Luke Popovich, a spokesman for the National Mining Association, said AEP's decision showed the shrinking appetite for capping carbon emissions in today's economic climate. Instead of retrofitting with costly technologies like CCS, he said, regulators should consider the improvements to emissions that could be achieved through efficiency upgrades and other means, like gasification." (Read more, subscription required)

Dean paying $140 million to Southeast dairies to settle suit; other defendants still in the dock

Dean Foods has agreed to settle a class-action, anti-trust lawsuit by more than 7,000 farmers in the Southeast, putting pressure on other defendants to settle before an Aug. 16 trial. “We feel the settlement amount of $140 million speaks to Dean's past activities in the Southeast and the impact those activities had on the dairy farmers,” Washington attorney Robert Abrams said.

"The case was filed in July 2007 in federal court in Tennessee against Dean, the Dairy Farmers of America cooperative and others," alleging that the companies conspired to stop competing for raw Grade A milk, driving down prices, the Washington newsletter Agri-Pulse reports. "Dean earlier settled a similar suit brought by farmers in the Northeast."

Chickens > problem > idea > invention > broadband > profit (and maybe a model to follow)

Not long after Mark Hamilton and Anna Hess first bought their 58-acre Appalachian farm, a friend gave them chickens, hoping for a share of fresh eggs. Challenges of caring for the poultry led to innovative thinking, and high-speed Internet access helped them sell their invention all over the world, creating another model for rural economic development and "a self-sustaining farm where the chickens feel spoiled," reports Willie Davis of Appalshop's new WMMT Print Service.

The farm is in Scott County, Virginia, where big tobacco farms once nestled between two coal-bearing mountains. Once income from the tobacco industry and the coal companies shriveled, "the county suffered," Davis reports. "The population has been shrinking since 1990, and over 20 percent of the residents live below the poverty line. Filling the void these tobacco farms left are small self-sustaining farms. With small farms come small-farm problems."

Hamilton and Hess needed a way to provide enough clean water for their chickens, and Hamilton designed the Avian Aqua Miser, a plastic container with a special nipple that allows chickens to drink water a drop at a time, to prevent spillage and contamination of uncovered vessels. "By selling the Miser on the Internet, we were able to pay ourselves a living wage, not just minimum wage," Hess told Davis. "That's hard for a lot of people around here to do." To purchase an Avian Aqua Miser, learn more about it or how to make a homemade chicken waterer, click here. To read the story, via the Daily Yonder, click here.

Law aimed at air pollution in L.A. region doesn't fit rural lifestyle of high desert, residents say

San Bernardino County, California (Wikipedia map), is the largest U.S. county in land area, 20,105 square miles, and it takes in very diverse territory, from dense suburbs of Los Angeles and Long Beach to the nearly empty high desert that stretches to the Nevada and Arizona borders. Now many residents in the high desert think their rural lifestyle is being threatened by a new law "that aims to reduce air pollution by encouraging higher density housing near transit centers, among other strategies to reduce reliance on the automobile," David Danelski of The Press-Enterprise in Riverside reports.

The law "seeks to reduce driving through what its proponents call 'sustainable' land-use planning for the next 20 years," Danelski writes. It law will "offer incentives for cities and counties that reduce sprawl and miles driven by approving higher density housing, such as apartment and condo complexes, near transit centers, places of employment and services," saccording to Hasan Ikhrata, executive director of the Southern California Association of Governments.

The law will be the topic of 16 public meetings, and Brad Mitzelfelt, a county supervisor, is urging residents to attend to defend their rural lifestyle. He said almost half of high-desert residents commute 40 or more miles to work, and "We cannot solve that problem in the high desert, and the air-quality issue that goes with it, by building condos above coffee shops next to bus stops." (Read more)

Rural areas no longer healthier than cities; county rankings provide detailed comparisons

"Americans residing in major cities live longer, healthier lives overall than their country cousins—a reversal from decades past," Melinda Beck reports for The Wall Street Journal. "Many cities that were once notorious for pollution, crime, crowding and infectious diseases have generally cleaned up, calmed down and spread out in recent years, while rural problems have festered. Rural residents are now more likely than other Americans to be obese, sedentary and smoke cigarettes. They also face higher rates of related health problems including diabetes, stroke, heart attacks and high blood pressure."

While cities still have more violent crime, air pollution, sexually transmitted diseases and babies with low birth weight, city residents "tend to rate their own health more highly and are less likely to die prematurely than rural Americans," Beck writes. Generally, suburbs are healthier than cities or rural areas. (Read more)

Those facts were assembled from County Health Rankings, a project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, designed to spur communities into action to improve their health. The rankings give health factors and health outcomes for every county.

Pa. fish commission leases waterways to natural-gas drillers for money to fix high-risk dams

In an effort to rebuild its high-risk dams, the Pennsylvania Fish and Boat Commission is planning "to lease portions of its 43,000 acres of waterways for natural-gas exploration," Richard Gazarik of the Pittsburgh Tribune-Review reports. The commission hopes the move will fill a $36 million budget shortfall.

"The agency needs a revenue source because the commission receives no state funds," Eric Levis, commission spokesman, told Gazarik. "It is supported by license fees and some federal money."

Donegal Lake, a popular trout-fishing area in Donegal Township, will be the first commission property to be drilled. Williams Production Appalachia, a branch of a Tulsa-based energy company, is building a drilling pad on private property near the Donegal Lake awaiting formal approval from the commission, Gazarik reports. (Read more)

"14,000 acres – or about one-third – of the commission's waterways are potential drilling sites," Levis told Gazarik, so in addition to Donegal, the commission has leased property in Clinton County and is is seeking proposals for a Lycoming County site. (Read more)

Geologists, environmentalists disagree on proposal to mine big uranium deposit in Virginia

A proposal for uranium mining in rural Virginia is being revived with support from the Virginia and West Virginia members of the American Institute of Professional Geologists. Virginia Uranium is hoping to mine Coles Hill, the 119-million-pound deposit "about 100 miles east of Pendleton County, W. Va," The Associated Press reports.

The president of the Virginias section of AIPG, Micale Lawless, told AP, "Members overwhelmingly support the Virgina mining as a way to diversify the nation's energy policy and ease reliance on foreign energy." (Read more)

But uranium mining is opposed by some environmental groups, like Keep the Ban, which distributed maps showing other uranium deposits that could be tapped if the ban is lifted. "It's a bigger can of worms than I think people recognize," the group's Nathan Loft told Liz Essley of The Washington Examiner.

Patrick Wales, the company's project manager, told Essley, "We've got 119 million pounds of uranium we can't do anything with, so that's enough for us. I think it's unfortunate that we have these environmental organizations that are pursuing their agenda that is not based on facts and not based on science." (Read more)

Dollar stores feel the squeezes their customers do

Here's the latest bad economic news: Dollar stores, which have expanded recently in rural areas and became more popular during the Great Recession, are failing to meet quarterly profit forecasts, reports Ann Zimmerman of The Wall Street Journal.

"In the past several weeks, Dollar General Corp., Family Dollar Stores Inc. and Dollar Tree Inc., the country's three largest chains that sell sharply discounted food, household staples and other items in modest-size stores, all have missed their quarterly earnings targets," Zimmerman reports, calling it "a sign that even fairly cheap toys and other small indulgences now are a stretch for some consumers." (Associated Press photo: Family Dollar aisle)

The companies blamed higher cost of fuel for hauling goods, but "also said their price-sensitive customers, pummeled by high unemployment, stagnant wages and soaring gasoline prices, are buying more food and other basics like cleaning products, which have relatively low profit margins, and fewer higher-margin discretionary products, such as apparel and home decorative items," Zimmerman writes. Also, the stories are squeezed by higher food prices, which "they have been reluctant to pass on to their struggling core customers, who typically have family income of less than $40,000." (Read more)

Colo. story shows process for post-office closings; some are spared but have fewer employees

With 2010 losses totaling $8.5 billion and more expected this year, the U. S. Postal Service "is doing all it can to be as efficeint as possible while stopping the financial bleeding," Al DeSarro, the service's Western-area spokesman, told Steve Block of The Trinidad (Colo.) Times Independent for a story on the post office in nearby Model. "We never want to close a post office but sometimes we have to. Our projection is that 2,000 to 3,000 will be closed in the next two to three years.” (MapQuest image; click on it for larger version)

"A Post Office Discontinuance Study . . . takes nine to 10 months," DeSarro said. We examine a post office for volume, number of visits, building lease costs, utilities and employee and transportation costs."

From such studies some post offices will be selected for closure while others will remain open, but perhaps with reduced service. In a letter to Sen. Mark Udall of Colorado, a district manager wrote, "The Postal Service occasionally interchanges staff, equipment and other resources in order to reduce operating costs, create greater efficiencies, and make better use of its resources."

The post office in Model is among those that will remain open with a reduction in services. The location will still provide post-office boxes, retail and mail-acceptance services, but starting Sept. 10, mail carriers will no longer work out of the Model post office, but the one in Trinidad, 21 miles away, Block reports. For a story about postmaster retirements and resignations driving closure decisions, click here; for one on Iowa officials' complaints about the process, go here.

Report outlines trends, differences between rural and non-rural hospital emergency departments

Is your hospital having trouble with its emergency room? A statistical brief by the federal Agency for Healthcare Research and Quality could provide grist and background for a story, because it reveals some trends and differences between rural and non-rural emergency departments.

Emergency visits have increased in recent years, but reimbursement for emergency care by insurers has decreased, Anika Hines, Taressa Fraze, and Carol Stocks report. "These challenges are magnified in rural areas, which typically have fewer health-care resources, including medical staff, facilities, adequate financing, and modern technologies."

The brief reports only 2.4 percent of rural emergency departments had trauma level designations in 2008, while 35.5 percent of non-rural emergency departments housed a Level I, II, or III trauma center. The brief also identifies hospital ownership and "critical access hospital" certification as significant differences among rural and non-rural hospitals. To see the entire brief including tables on hospital and patient characteristics and the top conditions for rural and non-rural emergency room patients, click here.

Ranchers vie to keep using brands as USDA prepares to release final proposal for tracking of cattle

Later this summer, the U. S. Department of Agriculture plans to release its final livestock and meat tracking proposal. While states and Indian tribes will have authority to select individual tracking methods, USDA will push ear tags as the preferred method, Shannon Dininny of The Associated Press reports. "Whether states also want to recognize brands is up to them," USDA Animal and Plant Health Inspection Service spokesperson Abby Yigzaw told Dininny. (AP photo of Washington rancher Craig Vejraska with branding iron)

Many ranchers are upset with the proposal because it veers from the branding tradition of the West. "We find this decision outrageous that the USDA would level a direct attack on what is an iconic symbol of our industry and what has been a tried, proven and effective means of conducting disease trace backs," Bill Bullard of R-CALF USA, an advocacy group for ranchers, told Dininny. The ranchers also argue that ear tags detach too easily.

Eldon White, executive vice president of the Texas and Southwestern Cattle Raisers Association, said he understands the USDA's position because Texas registers brands only at the county level, allowing duplicate brands within the state. Even so, he told Dininny: "Brands are still a very important method of owner identification in Texas and will continue to be so. We would be very concerned and would fight against a movement to eliminate the use of brands altogether." (Read more)

'Critical access' hospitals have poorer patient outcomes and lower quality of care, study finds

A study has found that small, rural hospitals with the "critical access" designation have poorer patient outcomes and lower quality of care.

The analysis, performed by researchers at the Harvard School of Public Health, focused on nearly 1,300 critical access hospitals, a designation is given to facilities that have 25 or fewer acute-care beds and are more than 35 miles away from another hospital. In return for such concessions as limiting patient stays, CAHs get extra Medicare and Medicaid reimbursements. The Rural Assistance Center has lists of CAHs in each state.

The study looked at the outcomes of Medicare patients who have congestive heart failure, heart attacks and pneumonia. For all three conditions, CAHs performed at a lower standard. For patients treated for heart attacks, CAHs provided care in keeping with Hospital Quality Alliance standards 91 percent of the time, compared to 98 percent at other hospitals. The difference was even larger for patients with congestive heart failure patients (80.6 percent vs. 93.5 percent) and smaller "but still significant" for pneumonia (89.3 percent vs. 93.7 percent), the report says.

Patients at CAHs were also more likely to die. They had higher 30-day risk-adjusted mortality rates for all three conditions than patients admitted to other hospitals. The study also found CAHs behind in the implementation of electronic health records, 6.5 percent to nearly 14 percent.

"Despite more than a decade of concerted policy efforts to improve rural health care, our findings suggest that substantial challenges remain," the study authors write. "Although CAHs provide much-needed access to care for many of the nation's rural citizens, we found that these hospitals, with their fewer clinical and technological resources, less often provided care consistent with standard quality metrics and generally had worse outcomes than non-CAHs." (Read more)