VRHA Weekly Update
In this Issue October 6, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available







In 2013, the Virginia General Assembly passed House Bill 1672, directing the Virginia Department of Behavioral Health (DBHDS) and Developmental Services, in conjunction with the Virginia Department of Health, the Virginia Department of Health Professions, law enforcement, and the recovery community, to conduct a pilot project on the administration of naloxone to counteract the effects of opiate overdose. Virginia is the 19th state (plus the District of Columbia) to have a naloxone administration program. The Virginia law provides “Good Samaritan” protection for lay rescuers administering naloxone to individuals who are experiencing an overdose, so long as those individuals are participating in the pilot project.  The Virginia law also provides “Third-Party” prescribing privileges, allowing medical professionals to prescribe naloxone to individuals who can then administer it to someone else. DBHDS, working with its partners, has designated the metropolitan Richmond area and the far southwestern area of the state as pilot regions and is working to implement this program, which it has named REVIVE!
REVIVE! was implemented in June 2014. Lay Rescuers who are participating in REVIVE! have received comprehensive training on recognizing overdose, administering naloxone, and encouraging the individual to seek treatment for their drug use. Lay Rescuers have been prepared for the possibility of withdrawal symptoms, and understand the need to stay with the victim until First Responders arrive.

This presentation at the 2014 VRHA Conference. will discuss the planning, preparation, implementation, and outcomes of REVIVE! in Virginia.  For more information about this and other sessions, click the conference logo above.

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Members in the News

By Rachael Smith - Nelson County Times

Describing herself as an “Army brat,” [VRHA member] Peggy Whitehead has lived all over the country — even in Puerto Rico during high school.

“It was great, I was just old enough to appreciate being somewhere different and go to school somewhere different but too young to have any major responsibilities,” she said. “It was a great opportunity to learn about a different culture and different people.” But when she ended up in rural Nelson County, she knew she was ready to plant roots. 

“I love how beautiful the county is,” she said. “When we look out our window we see mountains, and regardless of the time of year or the weather it’s still beautiful. It’s such a pleasant place to be and I have come to really appreciate being here.” 

She now serves as director of the Blue Ridge Medical Center, where she has worked for more than 20 years.

Read the full article.

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Many Members in the News

From the Health Resources and Services Administration

Administrator Mary K. Wakefield, PhD, RN, announced more than $22 million to support health care in rural areas, including funds that will provide resources and expertise for telehealth solutions, improve emergency medical services, and help communities build networks of care. Through grant programs administered by the Office of Rural Health Policy, located within HRSA, the awards went out to more than 100 rural communities in 42 states.

VRHA recipients are:

Rural Health Network Development - Giles Free Clinic
Patient-Centered Medical Home Facility Improvement Program - Blue Ridge Medical Center and Eastern Shore Rural Health Systems

Click here for the full press release and listing of recipients.

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Virginia News

Health Care Divide

From the Office of Senator Bernie Sanders

Bluefield, Virginia and Bluefield, West Virginia: They share the same name and for most residents, crossing the state line for work, errands, and appointments is a regular part of everyday life. While it can be easy to lose track of what side of the state line you’re on, for low-income adults without health insurance, one of the key differences is the differing decisions made by the Legislatures in West Virginia and Virginia regarding whether to expand Medicaid through the Affordable Care Act.

Joanna Sampson, 44, lives in Bluefield, Virginia, about a 15 minute drive from the Mercer Charitable Clinic in Bluefield, West Virginia. The Mercer Charitable Clinic, which also has sites in Beckley and Hinton, provides free primary care and prescription drugs and connections to specialty services to people living on both sides of the state line.

West Virginia is among the 27 states and the District of Columbia that have opted to expand their Medicaid programs to all individuals under 138 percent of the federal poverty level (about $33,000 a year for a family of four). While Virginia Gov. Terry McAuliffe has tried to expand Medicaid in his state, it has not yet happened.

While her employer offers health insurance at $90 a month, she says she “had to decline it because I can’t afford it. It’s just too much.” She considered moving across the state line to West Virginia so that she could enroll in Medicaid, but “I can’t afford that. Danged if I do, danged if I don’t. The state of Virginia needs it. And any other states that don’t have it, they need it too….Everybody needs healthcare. It’s just getting it, finding it, keeping it at a level people can afford it. You know you have got people that are either okay to eat or okay to pay for healthcare insurance and it shouldn’t be that way, it really shouldn’t.”

Read the full article and related story from Public News Service.

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Norton Expansion

By Allie Hinds - News Channel 11

A year after one Southwest Virginia hospital closes, another hospital announces a multi-million dollar expansion. Mountain States Health Alliance officials announced a more than 11 million dollar investment in to Norton Community Hospital.

The money will add a renovated and expanded emergency room with six more beds, a wellness center, and a new medical complex that will be home to outpatient services like rehabilitation, pharmacy, and surgery.

One doctor at Norton Community Hospital said with the more and more people unemployed in the region, many patients come to the emergency room for primary care.

Read the full article and learn more during the REVIVE! workshop at the VRHA Annual Conference.

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Overdose Training

By Allie Robinson Gibson - Bristol Herald Courier

If a program piloted in Southwest Virginia and metro Richmond goes well, saving someone from an opioid overdose could be as simple as administering an EpiPen.

The first public training for REVIVE!, a project overseen by the Virginia Department of Behavioral Health and Developmental Services, was held Thursday afternoon in Lebanon. In the pilot area — in metro Richmond and in Washington, Wise, Russell, Buchanan, Lee, Scott, Dickenson and Tazewell counties — organizations such as One Care of Southwest Virginia are training folks to recognize the signs of drug overdose and administer the nasal spray that will block the drugs and, hopefully, save lives.

Read the full article.

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National News

Speak Up for Rural Health

As your Congressional members return back home to prepare for the November election, please talk with them about rural health issues and how they affect your community.  NRHA has developed a set of talking points on:

  • Rural Issues and the ACA
  • Rural Issues and Sequestration
  • Attacks on Rural Hospitals Must Stop

Click here to download the set.


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Is Bigger Better?

By Tammy Worth - HealthcareDIVE

There is a general assumption that large primary care practices perform better than smaller, independent offices. These groups have more resources, often ones provided by hospitals that own the groups.

To test this theory, a study led by researchers at Weill Cornell Medical College surveyed small- and medium-sized primary care practices to compare the number of preventable hospital admissions of the groups' patients. 

Contrary to popular notions, the study authors found that the smaller practices had markedly fewer preventable hospital admissions. Groups with up to two physicians had 33% fewer ambulatory care-sensitive admissions than practices with 10 to 19 doctors. Those with three to nine physicians had 27% fewer than the larger groups.

Read the full article.

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Hospitals Pressured

By Robin Respaut - Reuters

In January, Linden Texas native Richard Bowden suffered a mild stroke. Within minutes, medics had taken the 68-year-old to the local hospital emergency room, less than a block from his house.

Shortly after returning home, Bowden learned he would outlast the hospital itself: the facility was about to close because there weren't enough patients. “It blindsided me,” he said. “It's 15 miles to the next hospital. Out in the country, that seems like a long way.”

Small, rural hospitals like Linden have always struggled to remain viable, but things are getting worse, fast. Rural communities are shrinking at a time when healthcare providers are being pressured to cut costs and release patients sooner.

Read the full article and related article by MuniNet.

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Rural Publications

Gender and age are associated with healthy food purchases via grocery voucher redemption
Grocery vouchers that specifically target foods associated with reduced cardiovascular disease (CVD) risk result in increased consumption of those foods. In regions with disproportionately high CVD rates, there is little research concerning the impact of vouchers on purchases of risk-reducing foods when there are no restrictions placed on grocery voucher redemption. Since many food assistance programs place few restrictions on type of foods that can be purchased, identifying demographic factors associated with purchasing habits is a prerequisite to promoting healthy eating. The purpose of this study was to determine the associations of age, gender, education and income level with purchasing of healthful foods through the use of a grocery voucher in a rural food desert (poverty rate of ≥20% and ≥33% of residents living >16 km from a large grocery store) with high rates of chronic disease.
The Future of the Frontier Extended Stay Clinic
Accessing emergency care in rural America can be very challenging, especially in frontier areas no matter how they are defined.1Hospitals are few and far between, and transporting patients may be significantly delayed because of weather, lack of traversable roads or airports, darkness, and other difficulties. In these cases, frontier clinics must care for patients until it is possible to transfer them. However, these clinics do not qualify for Medicare or other reimbursement for extended patient management services. In an environment where rural clinics are already struggling financially, providing uncompensated clinic-based extended stay services is financially unsustainable.
Home Health Care Agency Availability in Rural Counties (Key Facts &Full Report)
A range of medical services can be provided in the home setting, allowing patients to be discharged from hospital or inpatient rehabilitation settings more quickly. Medicare reimburses for six types of home health care:  skilled nursing, physical therapy, occupational therapy, speech pathology, medical social work, and home health aide services. In November 2011, the Centers for Medicare and Medicaid Services modified Medicare reimbursement for home health care, seeking to control costs by reducing inflation-associated adjustments in charges.  In the past, changes in reimbursement may have affected rural home health care agencies more adversely than those in urban areas.  The purpose of the current report is to describe the status of home health care service delivery in the rural U.S. in 2008, before passage of the Patient Protection and Affordable Care Act and related efforts.
Geographical and seasonal barriers to mammography services and breast cancer stage at diagnosis
Routine mammography screening and early detection are important prognostic indicators for breast cancer. Geographical and seasonal barriers to mammography services and relationship to breast cancer stage at diagnosis were examined.
Rural Hospital Mergers and Acquisitions: Who Is Being Acquired and What Happens Afterward?
Hospital mergers and acquisitions are changing the face of health care in both rural and urban communities across the country. Declining reimbursement levels, increased capital needs, a weak economy and easier access to credit have all contributed to a level of mergers not seen in more than a decade. This brief examines the implications of mergers and acquisitions for small rural hospitals, considering two primary research questions:

  1. What were the characteristics of rural hospitals that merged, and
  2. Were there changes in hospital financial performance, staffing or services following a merger? 

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Mark Your Calendar

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

October 10: A Small Physician Practice’s Route to ICD-10 - Blacksburg
October 17 - 18: Dental Care Approaches for Adults with Disabilities - Chesapeake
October 17-18: VTAction Community/Grassroots Organizer Training - Blacksburg
November 14: Virginia Oral Health Summit - Richmond
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton

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Helping Rural Seniors Age in Place
A brief from National Council of State Legislators provides a number of strategies states may want to consider that will help rural seniors age in place and live with dignity.

Find Telehealth Providers 
GIS mapping to assist with locating telehealth services in the Mid-Atlantic region.

Unequal Opportunity Killer
Cigarette smoking has devastating effects on health and it is an unequal opportunity killer. People with lower incomes, less education, and certain racial and ethnic minorities are more likely to smoke, so they bear a bigger share of the disease burden caused by the tobacco use epidemic. In conversations with several leaders in tobacco control, Unequal Opportunity Killer shines a spotlight on this health disparity, how it developed, and how tobacco companies have contributed.

CMS MLN Connects™ Weekly Provider eNews

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Funding Opportunities

Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multilevel Approach (UH2/UH3)
Deadlines: Letter of Intent (Required) - November 9, 2014 Application - December 9, 2014
Award ceiling: $625,000
Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multilevel Approach (UH2/UH3) will award grants to multidisciplinary teams to test an intervention or evaluate outcomes of an existing program or policy intended to reduce oral health disparities and inequalities, with the goal of improving oral health for low-income rural or urban populations. 

Rural Health Care Services Outreach Grant Program
Deadline: November 14, 2014; Award ceiling: $200,000 per year
Technical assistance webinar: September 24, 2014 from 1:00 - 2:30 ET.
Rural Health Care Services Outreach Grant Program supports projects that demonstrate effective and collaborative models of outreach and service delivery in rural communities. 

Hearst Foundations Grants
Application deadline: Applications accepted on an ongoing basis.
The Hearst Foundations are national philanthropic resources for organizations and institutions working in the fields of Education, Health, Culture, and Social Service.

National School Lunch After School Snack Program
Application deadline: Applications accepted on an ongoing basis.
Funding for schools to provide after school snacks to low-income children who participate in the National School Lunch program.

USDA Rural Child Poverty Nutrition Center Cooperative Agreement
Letter of Intent (Optional): Oct 20, 2014
Application deadline: Dec 1, 2014
Will award funds to establish a national center dedicated to reducing child food insecurity in persistently poor rural counties.

Griswold Cares Foundation
The Griswold Cares Foundation provides grants to nonprofit organizations throughout the country that enhance the quality of life for low-income seniors and adults with disabilities who choose to age in place. The Foundation's 2014 funding priorities focus on support for programs that provide respite care and short-term home care. The Foundation also supports local community and grassroots organizations who provide other programs and services with the intent of helping those of limited financial means to age in place. Most grants are in the $1,000 to $5,000 range. The application deadline is October 31, 2014.  

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