VRHA Weekly Update
In this Issue November 24, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities

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Finding Method in the Mayhem: 
Social Media Best Practices for Non-Profits

In the non-profit world, we are continually asked to do more with less…AND  WE ALL KNOW there is already SO MUCH TO DO! With its maelstrom of channels, adding social media to the marketing plan can seem daunting.  

When do we jump in? How do we jump in? Should we jump in? How much is enough? How much is too much? How much is too little? Which channels are right for us? Who will manage our efforts? What if something negative happens?

In this session at the VRHA Conference, Lisa Dove from the Virginia Community Healthcare Association will bring order from the mayhem as we explore social media best practices for non-profits. Afterward, your organization will be able to make more confident decisions on the integration of social media into your marketing efforts. Find your Method in the Mayhem!

Click the conference logo above for more information about the event.

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Members in the News

By ADA News

After selling his suburban private practice in Richmond, Va., six years ago, Dr. Ed Griggs decided to make a difference by working on the Eastern Shore, one of the most dentally underserved areas in the state.

Now, Dr. Griggs is one of four full-time dentists and four part-time dentists at [VRHA member] Eastern Shore Rural Health System, Inc., a Federally Qualified Health Center (FQHC), based in Onancock, Va. He is also the sole full-time dentist at the Atlantic Community Health Center, which has a state-of-the-art, seven-chair dental clinic. 

“There are just not enough dentists there to meet the need for basic dental services,” Dr. Griggs noted. “I realized that having a practice in Richmond met a need, but I could be easily replaced. Practicing on the Eastern Shore helped to meet a critical need.” 

Read the full article.

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Many Members in the News

VRHA members Wendy Welch, Bill Jacobsen and VCOM are all featured in this news story:

Joe Dashiell - WDBJ7

Rural health care is a long and winding road for many patients in southwestern Virginia.  Talk with local experts on rural health, and the extent of the problem quickly comes into focus.  

[Recruitment is] a struggle that rural hospitals throughout our region are facing.  When we visited the Edward Via Virginia College of Osteopathic Medicine in Blacksburg, dozens of hospitals in Virginia and neighboring states were selling their residency programs and their regions to the crowd of prospective doctors.

Read the full article.

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Virginia News

New Medical School Purpose

By Allie Robinson Gibson - TriCities.com

The board of the Southwest Virginia School of Medicine, formerly called the King School of Medicine, voted to take on a new name and identity altogether in the changing landscape of healthcare. The entity will be called the Alliance for Rural Health, and it will create a collaborative model to enhance education, research, clinical care and business development in the health care industry in Southwest Virginia.

The board will, next month, turn over the reins to a new board, made up of partner institutions, which include Emory & Henry College, East Tennessee State University, Virginia College for Osteopathic Medicine, Mountain States Health Alliance, Stone Mountain Health Services and the communities of Abingdon, Marion and Smyth and Buchanan counties.

Read the full article.

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Savings Can Happen in Virginia

By The Commonwealth Institute

Nationwide, 27 states and Washington, D.C., have freed up precious resources for critical needs like education by closing their health coverage gaps and saving money on medical care. The same could be true for Virginia, to the tune of $161 million.

This new report looks at how four states – Arkansas, Kentucky, Michigan, and New Mexico – are seeing actual savings of millions of dollars in their state budgets as a result of closing the coverage gap, the same way Virginia could if state lawmakers dropped their misguided opposition to the move.  Virginia could save $161 million next budget year by closing the coverage gap, helping to offset the budget shortfall.

Read the full article.

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Stone Mountain Model

The Rural Assistance Center (RAC) has singled out Stone Mountain Health Services of Pennington Gap, Virginia as a "Tools for Success" on the RAC website for the Behavioral Health Internship.

The Stone Mountain Health Services (SMHS) Behavioral Health Internship was developed to address behavioral health workforce needs in rural Appalachian communities of southwest Virginia. The region's population has behavioral health needs due to chronic disease rates, substance abuse rates, and stress related to an economically depressed region which is rural and often isolated in nature. There has been a shortage of behavioral health providers in the region, making access difficult from the aspects of travel time, cost, and long wait times for appointments. Prior to development of the internship, it was difficult for behavioral health education programs to find rural internships for their students. 

The internship uses an integrative behavioral health model, with the behavioral health intern serving as a member of the primary care team. Interns address traditional behavioral health issues, in addition to obesity, tobacco use, substance abuse, and other concerns where behavioral changes can improve the patient's quality of life. 

Read more.


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National News

Rural Hospitals in Critical Condition

By Jayne O'Donnell and Laura Ungar - USA TODAY

Stewart-Webster Hospital had only 25 beds when it still treated patients. The rural hospital served this small town of 1,400 residents and those in the surrounding farms and crossroads for more than six decades. But since the hospital closed in the spring of last year, many of those in need have to travel up to 40 miles to other hospitals. That's roughly the same distance it takes to get from Times Square to Greenwich, Conn., or from the White House to Baltimore, or from downtown San Francisco to San Jose. Those trips would be unthinkable for city residents, but it's becoming a common way of life for many rural residents in this state, and across the nation.

Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state's closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.

Read the full article.  THEN FOLLOW UP: VRHA & NRHA encourages you to call or email Congress today and register for the Rural Health Policy Institute to speak to your representatives in person to continue the fight for rural health access.

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Orphan Drug Enforcement Action

By the National Rural Health Association

The federal government has told drug manufacturers that they must give rural and cancer hospitals refunds for certain high-priced medicines. This enforcement action will go far in helping these providers better serve their vulnerable patients.
In July, the Health Resources and Services Administration (HRSA) set a new rule requiring drug makers to provide reduced pricing through a federal drug discount program on orphan drugs when used for common conditions. So far, most manufacturers have disregarded it. Rural safety-net hospitals are often the only venue of medical assistance in their communities. They operate on razor-thin margins and depend on savings from a drug discount program called “340B” to help keep their doors open.
National Rural Health Association CEO Alan Morgan added: “We agree that drug companies ignoring the law should be obligated to refund rural safety-net providers. At a time when our hospitals are experiencing substantial losses or barely breaking even, it is more important than ever for our providers to be able to access affordable medications. We don’t want more rural hospitals closing and 340B can really make a difference for providers and their communities.”

Read the full article.


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Pharmacy Access

By Eileen Oldfield - Pharmacy Times

Nearly 1000 independently owned pharmacies have closed over the past decade, leaving 490 rural areas without access to retail pharmacy services, recent research has revealed. 

“Loss of pharmacists in rural areas, particularly in areas where there was only 1 pharmacist in the community, can have serious implications for health care provision,” the study authors wrote. “Independent pharmacists are of particular concern as they are more likely to operate in underserved and rural areas and face additional business challenges from their limited ability to negotiate with pharmacy benefit managers, drug wholesalers, and health plans.”

Read the full article.

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Rural Publications

Deepening the quality of clinical reasoning and decision-making in rural hospital nursing
Deep clinical reasoning and decision making is a function of reflection and self-correction that requires a critical self-awareness and is more about how nurses think than what they think. The degree of sophistication in reasoning of experts and novices is at times equivalent in that the reasoning of experts and novices can be somewhat limited and focused primarily on human physicality and less on conceptual knowledge. To become proficient in clinical reasoning, practice is necessary. The study supports the accumulating evidence that using clinical simulation and reflective interviewing that emphasize how clinical decisions are made enhances reasoning skills and confidence.

Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
Describes features of states’ blueprints to operate state-based insurance marketplaces that have particular relevance to rural areas. Presents different states’ approaches to service areas and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program. 

Geographic Variation in Premiums in Health Insurance Marketplaces
This Policy Brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act. Using methodology developed in an earlier Policy Brief, we find that initially, a state-based marketplace design and an “MSAs+1” rating area design are associated with lower average premiums. Rating areas with more than 1000 people per square mile also tend to have the lower premiums. We find that the rating areas with the highest average premiums are characterized by smaller populations, greater land areas, and far fewer health providers per square mile. 

Geographic Variation in Plan Uptake in the Federally Facilitated Marketplace
In September 2014, the U.S. Department of Health and Human Services released data showing that nearly five and a half million individuals had selected an insurance plan in the 36 states where the Federally Facilitated Marketplace was operating.  This brief combines the recently released data on plan selection in the Federally Facilitated Marketplaces with estimates of the population likely to qualify for the marketplace (i.e. “eligibles”) to calculate the percent of potential eligible individuals who chose a plan (the “uptake rate”). The brief also contains a heat map that shows variation in uptake rates across the country. 

Differences in Case-Mix between Rural and Urban Recipients of Home Health Care
(Key Facts & Full Report)
Medicare pays for home health care for beneficiaries who require certain services but for whom travel to receive care is physically and/or mentally difficult or not medically recommended. Covered services include skilled nursing care; physical, occupational and speech-language pathology services; medical social services; and home health aide services. A beneficiary who has experienced a stroke and needs rehabilitative and support care during the recovery period is one example.  Home health care is both an important part of the care continuum for Medicare beneficiaries and a major program cost.  However, little information about the actual health status and needs of the population receiving home health services has been published. Thus, the purpose of the analysis reported here is to provide a thorough, clinically based description of the health status and service needs of rural and urban Medicare home health patients based on a professional assessment of their condition at the start of care. The Centers for Medicare and Medicaid Services (CMS) requires that each home health care recipient be assessed at the start of care using a set of questions developed to reflect the specific needs of home health patients.  
Rural Children Increasingly Rely on Government Programs for Health Insurance 
A new analysis for First Focus by Bill O’Hare shows that children in rural communities are more likely than their urban counterparts to get health care through the Children’s Health Insurance Program (CHIP) and Medicaid. With federal funding for CHIP scheduled to end next year, this report illustrates the importance of extending CHIP funding for children in rural America.

Observation Care Services for Medicare Beneficiaries in Rural Hospitals: Policy Issues and Stakeholder Perspectives
Describes the findings of a qualitative study aimed to gain a greater understanding of the rural policy context surrounding the use of observation care services by Medicare beneficiaries from 2010 to 2013. 

Does Rurality Affect Observation Care Services Use in CAHs for Medicare Beneficiaries?Describes the use of observation services across levels of rurality by Medicare beneficiaries in CAHs, the demographics and health status of patients receiving these services, and the characteristics of their observation stays.

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Mark Your Calendar

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

December 5: Remote Area Medical - movie and discussion - Washington, DC
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton
February 3-5: Rural Health Policy Institute - Washington, DC
March 29-31: Shaping the Future of Healthcare through Innovation and Technology - White Sulphur Springs

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The National Institute on Drug Abuse (NIDA) is making it even easier to use materials from its PEERx teen prescription drug abuse program. PEERx, part of the NIDA for Teens initiative, provides science-based resources to encourage open discussions with teens about this important issue. These resources are now available on a free flash drive for use by rural health professionals who do not have reliable Internet access in their classrooms or at events.
Order your free flash drive by emailing peerx@iqsolutions.com. Also visit http://teens.drugabuse.gov/  for NIDA’s teen blog and resources for National Drug Facts Week, an annual week-long observance when organizations and schools across the country host educational, community-based activities and events. 

Rural Assistance Center (RAC) Calendar
View upcoming rural events by month, state or keyword search.

Revised Centers for Medicare & Medicaid Services (CMS) 855R Application - Reassignment of Medicare Benefits
The revised CMS 855R application will be available for use on the CMS.gov website as of December 29, 2014. MACs may accept both the current and revised versions of the CMS 855R through May 31, 2015, after which the revised CMS 855R application will be required to be submitted.  After May 31, 2015, MACs will return any newly submitted CMS 855R applications on the previous version (07/11) to the provider/supplier with a letter explaining that the CMS 855R has been updated and the current version of the CMS 855R (11/12) must be submitted. 
Physicians, non-physician practitioners, providers, and suppliers must use the revised CMS 855R application starting June 1, 2015. The revised CMS 855R has been streamlined and some sections have been re-ordered for clarity. The revised form includes an optional section for primary practice location address. This information is shared with other programs such as Physician Compare to help beneficiaries identify where their physicians are primarily practicing. This address must be one that is affiliated with the individual/organization where the benefits are being reassigned.

ICD-10 Implementation Resources for Road to 10 *Medical Specialties and Association Partners
This page includes downloadable materials your organization can use to introduce the Road to 10 website, resources, and training.

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Funding Opportunities

Development and Translation of Medical Technologies to Reduce Health Disparities (R43/44)
Letter of Intent (Optional): Apr 28, 2015
Application deadline: Sep 7, 2015
Awards funding to small business concerns to develop and test medical technologies aimed at reducing disparities in healthcare access and outcomes.

Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R21)
Application deadline: Nov 17, 2016
Awards funding for research related to projects on Health Information Technology projects. Funding may be used for pilot/feasibility studies, data analysis, or economic analysis.

Community Access to Child Health (CATCH) Implementation Funds Program
Application deadline: Jan 30, 2015
Funding to support pediatricians in the initial and/or pilot stage of implementing a community-based child health projects related to medical home access, health services to uninsured/underinsured, secondhand smoke exposure, immunization programs, and Native American child health.

Mary Byron Foundation: Roth Award for Underserved Populations
Application deadline: Jan 31, 2015
Awards to honor programs that demonstrate promise in ending the cycle of domestic violence in underserved populations.

Youth Service America: Sodexo Foundation Youth Grants
The Sodexo Foundation and Youth Service America (YSA) are looking for 100 of the best ideas from young people about how they can help end childhood hunger in their communities. Sodexo Foundation Youth Grants of $400 are available for youth-led service projects that bring together young people, families, Sodexo employees, and other community members to address childhood hunger. Young people in the United States, ages 5 to 25, are eligible to apply. Funded projects should take place on or around Global Youth Service Day, April 17-19, 2015. The application deadline is January 15, 2015.

Department of Health and Human Services
The Centers of Excellence on Environmental Health Disparities Research funding opportunity, a joint effort of the National Institutes of Health and the U.S. Environmental Protection Agency, supports research projects that aim to understand the causes of environmentally driven health disparities and how to prevent them. This understanding should include relationships between biological, chemical, environmental, genetic, and epigenetic factors and social determinants of health. The application deadline is January 9, 2015. 

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