VRHA Weekly Update
In this Issue December 12, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available





Members in the News

By Whitney Stokes - Edward Via College of Osteopathic Medicine

Over the past few months the nomination and application process for the Student DO of the Year Award from the VCOM Virginia campus has been taking place, and this week the winner was selected. This award is presented annually by the Council of Osteopathic Student Government Presidents to a student who exemplifies leadership, community service, dedication to the profession, and embodiment of the ideals of the osteopathic philosophy. 
On behalf of the selection committee I am happy to announce that this year’s winner from our campus is [VRHA member] Katherine Kirby, OMSIII. Katherine has served in many leadership roles during her time at VCOM including serving as the National Liaison Officer for SOMA during the 2015-2016 academic year. She currently serves as the National Public Relations Director for SOMA on the national level and will continue to serve SOMA as the National Chairperson beginning in April 2017. Here at VCOM she also co-led the SOAP Notes and served as an Orientation Leader. She was awarded National Honorary Distinction from the Omega Beta Iota organization, the National Osteopathic Political Action Honor Society. She also participates in various community service efforts as part of her membership with multiple organizations on campus. 
As the award winner from the VCOM Virginia campus Katherine will be nominated for the national Student DO of the Year Award along with the other award winners from osteopathic schools around the country. The national selection and award announcement will take place this spring at the AACOM Annual Meeting. The selection committee believes Katherine will be a great representative from our campus at the national level, and we hope you will join us in congratulating Katherine.  The committee also wishes to thank all students and faculty who submitted nominations and applications for this award. 

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More Members in the News

By Stephanie Porter-Nichols - SWVA Today

[VRHA member] Smyth County Community Hospital’s CEO was frank about the challenges of physician recruitment as he addressed the Marion Town Council Monday evening. However, he was equally firm that SCCH is working diligently to bring quality doctors to this hospital and community.
James Tyler came before the council at its request. In November, council members gave voice to citizens’ concerns about the loss of surgeons at SCCH and the fear regarding the proposed merger of Mountain States Health Alliance (MSHA) and Wellmont. MSHA is the parent network of SCCH.

Read the full article.

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Virginia News

Naloxone for All

By Gregory S. Schneider - Washington Post

Virginia’s health commissioner declared opioid addiction to be a public health emergency and issued a standing prescription for any resident to get the drug Naloxone, which is used to treat overdoses. Gov. Terry McAuliffe (D) said the actions are in response to not only the rising problem of painkiller overdoses, but also to evidence that a synthetic large-animal sedative called Carfentamil is being abused in Virginia.

U.S. Surgeon General Vivek Murthy issued a report urging the nation to treat addiction as a chronic illness and calling the crisis “a moral test for America.”

Nationally, 78 people die every day from opioid overdoses, according to Murthy. In Virginia, three people die every day from an overdose and more than two dozen are treated in emergency rooms, according to the state health commissioner. Emergency room visits for heroin overdoses were up 89 percent through September in Virginia compared with the same period last year.

Read the full article and related legislation recently proposed in the General Assembly.

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Talking with Dr. Hazel

From Williams Mullen

Williams Mullen recently interviewed Virginia Secretary of Health and Human Resources Dr. Bill Hazel to discuss the current health care system and health care forum. Secretary Hazel’s thoughts are set out below: 

What do you see as the two primary challenges in health care in Virginia during the next two years?

"The biggest issue we face is getting the mental health system better organized, better funded, more responsive and more available to the community. The opioid epidemic signifies the surge in addiction issues we are addressing.

One of three things happens to individuals with addiction – they die; they live in addiction with harm to themselves, their family and their community with increased crime, incarceration, emergency room usage, etc.; or they recover. Those are the three choices. We need to get the recovery piece done. The parallels with mental health are very similar.

Another big issue is the access to health care problem has not been solved completely. It becomes an issue of how do we make health care affordable for people and for the country.

We have to address the market breakdowns, or acknowledge that we do not have a market, one or the other. When you compare U.S. health care spending to European health care spending, it is clear the Europeans do not have the high prices that we have in the U.S. We are running 50 to 60 percent higher. It is not easy to talk about, but that is where the conversation is going to have to go."

Read the full interview transcript.

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Close to Home

By Sam Owens - STAT

Hazard, KY — The patients here ask about the treatment by name. They’ve seen the crisp, alluring ads on TV and heard the soothing spots on the radio: Harvoni, they know, could cure their hepatitis C.
But in this town, carved into the Appalachian mountains, in a state beset by hepatitis C rates seven times the national average, Harvoni and other new hepatitis C drugs remain largely out of reach. Over the past year, only 3 percent of the state’s Medicaid beneficiaries with the disease received treatment.
“It’s very hard to see the patient and just tell them, ‘I can’t treat you,’” said Dr. Fares Khater, an infectious disease doctor in nearby Whitesburg.
A major reason is cost, with list prices for some 12-week treatment courses approaching $100,000. But a series of other forces helps explain why Kentucky is struggling to respond to the hepatitis C crisis, including a growing opioid epidemic that is fueling new cases and a changing patient base that is demanding hard choices be made about who gets treatment first.

Read the full article.

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National News

Maintaining Financial Health

By Joe Lawlor - Portland Press Herald

Rural hospitals like Mayo Regional Hospital are increasingly relying on rehabilitation and other outpatient services – such as physical and occupational therapy and primary care. At the same time their inpatient count – and the revenue that goes with it – has dwindled.

Rural hospitals are caught in a financial squeeze even as larger hospitals are investing in massive expansions. Mayo has a $50 million budget and is coping with an expected $1.2 million deficit for the 2015-16 fiscal year.

“We are actually one of the more financially healthy rural hospitals, and we have a $1 million hole in our budget,” said Marie Vienneau, Mayo’s CEO.

Many trends cut against rural hospitals. In 2006, the average daily census at a rural hospital in the United States was nearly 20 inpatients. By 2015, the average daily census had declined to 15.4, a nearly 25 percent decrease, according to the North Carolina Rural Health Research Center at the University of North Carolina.

The population is trending older and poorer – more so than urban and suburban regions – which means people need more health care, but the payments to the hospitals are lower. That’s because government reimbursements like Medicare and Medicaid pay hospitals less than what private insurers pay.

Read the full article.

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Mobile Team to Address Addiction

By Allee Mead - RHI Hub

In Pennsylvania, more people are dying from drug overdose than from car accidents. The state, 7th in the nation in drug overdose mortality rates, had over 3,000 people die from heroin overdoses from 2009 to 2013.
The rural counties of Armstrong, Indiana, and Clarion have been hit especially hard by the opioid crisis. Many residents of these counties work in the coal mines, steel mills, and logging industries. Since these are active, physical jobs, many residents were prescribed opioids for their injuries or chronic pain.

The Armstrong-Indiana-Clarion Drug and Alcohol Commission (AICDAC) was able to launch a mobile team to travel among the counties’ hospitals and provide support and education to adults and adolescents showing signs of substance use disorders. The Addiction Recovery Mobile Outreach Team (ARMOT) program is a collaboration of three hospitals, two substance abuse providers, and AICDAC.

The ARMOT Program’s goals include screening patients for substance use disorders, referring patients to drug and alcohol assessment and subsequent necessary treatment, educating medical staff on addiction and recovery issues, and assisting patients with substance use disorders to bridge the gap between behavioral and physical health services.

Read the full article.

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Police and Mental Illness

By   - Oklahoma Watch

For the mentally ill and emotionally troubled, encounters with law enforcement officers and incarceration in jails pose a risk of death. A spike in fatalities in Oklahoma jails this year and several confrontations between police and the mentally ill since 2014 have raised questions about whether officers and jailers are sufficiently trained to deal with people with mental health problems. Training data indicates it is a special concern in rural areas.

In Oklahoma jails, the number of suicides through October this year is higher than it has been in each of the last eight complete years, driven by a rise in suicides in the Oklahoma County Jail and in rural county and police jails. Several incidents have raised the issue of whether officers and jailers are trained well enough to deal with the behavior of mentally ill people.

Read the full article.

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Retired Veterans

By Mike Rosmann - InForum

Military veterans often choose to live in rural areas and pursue agricultural careers after they retire from military duty, and the trend is advancing. A disproportionately high percentage of military enlistees originate from rural backgrounds — about 44 percent — even though the federal government says about 17 percent of all Americans reside in areas defined as rural by the Office of Management and Budget. When soldiers retire from the military, they often want to live in rural locations, and many wish to pursue agricultural careers.

Why do veterans want to become involved in agriculture? Many people leaving the military originate from rural areas and want to return to their roots. They hope to reintegrate with their communities, and that may include farming.
A 2015 unpublished study of rural veterans who undertook agricultural occupations reports improvements in their physical and mental health, sleep patterns, nutrition, exercise and decreases in pain, anxiety, depression, medication use and substance use. The study used self-report and objective measures of physical and behavioral health.

Read the full article.

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar

December 16: Dental Care Approaches for Adults with Disabilities - Wytheville
December 16: SBIRT: An Integrated Model for a Lifespan Approach - Roanoke
February 5-8: Rural Healthcare Leadership Conference - Phoenix, AZ
February 7-9: 28th NHRA Rural Health Policy Institute​ - Washington, DC

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MLN Connects Provider eNews

CMS Finalizes Hospital Outpatient Prospective Payment Changes for 2017
The Centers for Medicare and Medicaid Services (CMS) announced the removal of the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The survey questions regarding how patients’ pain was treated in the hospital remain part of the survey; however, their answers no longer have an impact on the hospital’s funding.  In a recent fact sheet CMS stated "Although CMS is not aware of any scientific studies that support an association between scores on the pain management dimension questions and opioid prescribing practices, we are finalizing the removal of the pain management dimension of the... survey... in an abundance of caution." 
  • Learn more about the Prospective Payment System changes here.  
  • Learn more about the Administration's efforts to address opioid misuse and overdose here.
The Children's Health and Education Mapping Tool
An interactive mapping resource that focuses on education and health disparities among low-income children using geographic information systems (GIS). County-level data and statistics included for child health, education, and socioeconomic status.

MACRA and You
Primer covering the key components of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), focusing on participation requirements, payment models, and implementation options for rural healthcare providers.

RHC Guide to the MACRA Final Rule
Answers common questions, in question and answer format, about the Medicare Access and CHIP Reauthorization Act (MACRA) and how it will affect Rural Health Clinics (RHCs). Main areas of focus include billing changes, the low-volume exemption, and the Merit-based Incentive Payment System (MIPS) reporting requirements.

Rural America at a Glance, 2016 Edition
A report that provides an overview of social and economic factors affecting rural America. Includes data and statistics about employment, population, poverty, and income trends.

Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples
Summarizes the work of 70 Federal Office of Rural Health Policy grantees who implemented evidence-based health interventions in rural settings. Identifies themes in grantees' experiences and discusses program adaptations for rural and frontier settings.

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Funding Opportunities

For funding opportunities without a specific deadline, please visit the VRHA Resources page

Virginia Health Safety Net Grants
Funding for projects to grow and strengthen Virginia's healthcare safety net by developing or expanding patient capacity; establishing a broader scope of services; creating local systems of care; or strengthening infrastructure.
Letter of Intent (Required): Jan 20, 2017
Application Deadline: Mar 8, 2017

Appalachian Community Fund Technical Assistance Grants
Funding for technical assistance needs for community-based organizations that address underlying causes of economic and social distress in the Appalachian region.
Geographic coverage: Appalachian counties of Tennessee, Kentucky, Virginia, and West Virginia

Virginia EMS Training Funds Program
Provides funding for EMS Certification programs, auxiliary programs, and continuing education programs.

Primary Care Medicine and Dentistry Clinician Educator Career Development Award
Grants to strengthen the primary care workforce by training and supporting physicians, physician assistants, dentists, and dental hygienists who plan to teach in the primary care fields.
Application Deadline: Feb 13, 2017

Agricultural Safety Grants
Awards funding to local or regional agricultural health and safety intervention projects to provide practical education, training, and/or communication tools that can be shared widely with the agricultural community to facilitate timely application of evidence-based safety/health strategies to protect all agricultural workers.
Letter of Intent (Required): Dec 15, 2016
Application Deadline: Jan 4, 2017

The Mary Byron Project: Celebrating Solutions Awards
The Mary Byron Project cultivates and supports efforts that extend beyond crisis management to attack the root causes of the domestic violence epidemic. The Project’s Celebrating Solutions Awards recognize innovative programs that demonstrate promise in ending the generational cycle of domestic violence. The focus is on pioneering programs that can serve as models for the nation. Four awards of $10,000 are presented each year. (An additional Roth Award of $10,000 recognizes one program that specifically addresses the needs of underserved populations.) Programs that have been in operation for a minimum of three years are eligible for the awards.
Nominations for Celebrating Solutions Awards must be postmarked by January 31, 2017. Nominations for the Roth Award must be postmarked by February 28, 2017.

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