VRHA Weekly Update
In this Issue  November 28, 2016

VRHA News Virginia News National News Mark your calendar
Resources
Funding Opportunities
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VRHA News

Members in the News



Rockbridge Area Community Services has been training law enforcement officers to become members a Mental Health Crisis Intervention Team. Now, in cooperation with [VRHA member] Carilion Stonewall Jackson Hospital, they have a Crisis Intervention Assessment Site. John Young is Executive Director of Rockbridge Area Community Services.

"Basically what that means for our area is folks that might be under the emergency custody order--whether it be paper or paperless--during the operational hours of the program are brought in to that site directly and two sheriff's deputies are available at all times at that site and can do transfer of custody."

The service area covers Bath County, Buena Vista, City of Lexington and Rockbridge County and having the Crisis Intervention Assessment Site means law enforcement officers will be able to get back to their beats more quickly.

Read the full article.

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More Members in the News

VRHA members were recently recognized by the Leapfrog Group for their quality of patient services. The Leapfrog Group advocates for quality and safety of American health care. Its Hospital Safety Grade survey collects and reports on hospital performance based on its record of patient safety. According to the Leapfrog Group, 1,000 people die each day in the U.S. as a result of preventable hospital errors.

Receiving high performance reviews were VRHA members Warren Memorial HospitalMountain View Regional Medical Center and Lonesome Pine Hospital.

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Virginia News

Public Health Emergency

From the Office of the Governor

Governor Terry McAuliffe announced that State Health Commissioner Marissa J. Levine, MD, MPH, FAAFP, has declared the Virginia opioid addiction crisis a Public Health Emergency.
This declaration comes in response to the growing number of overdoses attributed to opioid use, and evidence that Carfentanil, a highly dangerous synthetic opioid used to sedate large animals such as elephants, has made its way its way into Virginia. A Public Health Emergency is an event, either natural or manmade, that creates a health risk to the public.

“Too many families across Virginia and the nation are dealing with heartbreak and loss as a result of prescription opioid and heroin abuse epidemic,” said Governor McAuliffe. “We cannot stand by while these drugs harm our communities and our economy. That is why I support Dr. Levine’s decision to declare a public health emergency, to heighten awareness of this issue, provide a framework for further actions to fight it, and to save Virginians’ lives.”

In response to the Public Health Emergency, and in partnership with Virginia’s Board of Pharmacy, Department of Health Professions and Department of Behavioral Health and Developmental Services, Dr. Levine has issued a standing order that allows all Virginians to obtain the drug Naloxone, which can be used to treat narcotic overdoses in emergency situations. 

Read the full press release and related story from WAVY.

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Preparing for Changes

By Michael Martz - Richmond Times Dispatch

A new legislative subcommittee will monitor health care policy changes that President-Elect Donald Trump proposes in order to help Virginia lawmakers prepare for either the repeal or repair of the Affordable Care Act, as well as other potential shifts in federal health care laws under the new administration.

House Appropriations Chairman S. Chris Jones, R-Suffolk, and Senate Finance Co-Chairman Emmett W. Hanger Jr., R-Augusta, said Wednesday that a small working panel would allow the legislature’s budget committees to respond more quickly to policies that emerge from the Trump administration after the General Assembly adjourns in late February.

The creation of a joint committee also reflects the uncertainty in Richmond over what will happen to the health care law that outgoing President Barack Obama championed and how those changes could affect hundreds of thousands of Virginians who have bought insurance from the federal marketplace and rely on an estimated $1 billion in subsidies to pay for it.

Read the full article and related stories from NBC29 and UVA Today.

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Jail & Mental Health

By Carmen Forman - Roanoke Times

Virginia’s jails and mental health hospitals are inextricably linked. The large number of mentally ill inmates in Virginia’s jails is caused, in part, by the lack of open beds at the state’s nine psychiatric hospitals — two of which state lawmakers considered closing earlier this year.

Members of the Senate Finance Committee met at the Inn at Virginia Tech to hear strategies to improve mental health options across the state so as to reduce incarceration of people with severe mental health problems like post-traumatic stress disorder, schizophrenia, depression and bipolar disorder.  But the sessions were preceded by a look at Gov. Terry McAuliffe’s updated budget that includes a $1.5 billion revenue shortfall.

During budget talks, legislators were encouraged to think about measures to cut state spending. At the latter presentations, financial analysts warned none of the mental health solutions mentioned are possible without additional spending and thus, unlikely to occur in the short-term.

In June, there were about 3,300 mentally ill offenders — or about 8.4 percent of all incarcerated offenders — in local and regional jails across the state. Roanoke’s jail is one of the 12 jails that account for nearly two-thirds of all seriously mentally ill inmates in Virginia.  The State Board of Corrections gives each jail the ability to set its own mental health practices; the board only requires each jail have a written policy of how it handles inmates in need of treatment. The board does not mandate any mental health training for jail employees.

Deputy Staff Director Dick Hickman called the high number of seriously mentally ill inmates a symptom of a bigger problem — the inadequate capacity of the state mental health system.

Read the full article.

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National News

MACRA and You

From the National Rural Health Association

Providers in rural America need to be aware of the changes coming as a result of the Medicare Access and CHIP reauthorization Act of 2015 (MACRA) regulation recently promulgated by CMS. MACRA attempts to realign physician payments under Medicare to from volume to value. MACRA offers providers that participate in Medicare Part B two options to demonstrate value: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (AAPMs).

NRHA has extensively reviewed the rule and outlined what rural physicians and providers must know and consider. NRHA has been participating in the process since the inception of MACRA to ensure rural practices were considered, working with lawmakers and regulators to vigorously advocate for rural providers. We will continue to provide information about the law and its implementation moving forward to assist rural providers in understanding the way quality and value are measured under MIPS. NRHA will continue to provide additional guidance and advocacy opportunities through webinars and conferences.

Additional resources are also available on the CMS Quality Payment Program website designed to help providers understand the regulation.

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Early Childhood Intervention 

By Wade Goodwyn - NPR

Last year, the Texas legislature approved a $350 million cut in Medicaid reimbursement rates to early childhood intervention therapists and providers. The cuts, made to help balance a billion dollars in property tax relief, affect the most vulnerable Texas children — those born extremely prematurely or with Down syndrome or other genetic conditions that put them at risk for developmental delay.

For months, providers of in-home physical, speech and occupational therapies have continued to serve children who have disabilities, despite mounting financial losses. Now some have had to shut their doors, curtail services or halt their home-visit programs, leaving many children without treatments their parents feel are crucial to the kids' well-being.

"Sometimes you need to come out to these rural areas and see how things are done — and how they have to be done — and even talk to some of the parents before you just decide to cut a program," said Waymon Stewart, the executive director of the Andrews Center in Tyler.

Stewart predicts that children with profound disabilities will suffer most from the closure of his program and others like it, especially in rural regions. It's not uncommon for early childhood intervention therapists to have to drive an hour each way to get to far-flung patients. For children who are prone to seizures, or who have to be connected to machines for daily living, long trips in the car several days a week for treatment in other clinics are simply not going to happen, he says.

Read the full article.

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Lost in Translation

By Michael Ollove - Governing

New federal rules requiring thousands of hospitals, doctors and dentists to provide free interpretation and translation services for people who don’t speak English aim to prevent tragedies. 

The new rules, which apply to providers who receive Medicaid reimbursement or other federal funds, are expected to expand access to preventive care and reduce medical costs, at least in the long run. A language other than English is spoken at home in 21 percent of U.S. households.

But some struggling rural hospitals and smaller medical and dental practices are worried about the cost of following the new rules, which require them to offer interpretation and translation services for the most popular 15 languages in their state.

Read the full article.

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Rural Health Publications

Trends in Risk of Financial Distress among Rural Hospitals
From January 2005 to July 2016, 118 rural hospitals have closed permanently, not including seven others that closed and subsequently reopened. The number of closures has increased each year since 2010, and in the first half of 2016, the closure rate surpassed two closures per month. Hospital closures impact millions of rural residents in communities that are typically older, more dependent on public insurance programs, and in worse health than residents in urban communities. Identifying hospitals at high risk of closure and assessing the trends over time may inform strategies to prevent or mitigate the effects of closures. In a previous findings brief the NC Rural Health Research Program described the Financial Distress Index (FDI) model, which assigns hospitals to high, mid-high, mid-low or low risk levels for 2016 using 2014 Medicare cost report and Neilsen-Claritas data summed to market areas. Using data from 2011-2014, this brief updates and describes the distribution and trends in the risk of financial distress among rural hospitals for the 2013-2016 period by state and census region. 

Medicare Advantage Enrollment Update 2016
Analysis of Medicare Advantage (MA) enrollment data from March 2015 and March 2016 showed that national enrollment in MA and other prepaid plans increased from 16.7 to 17.6 million enrollees (from 31.1% to 31.5% of eligible beneficiaries). This 5.5% national growth rate is significantly lower than that seen in previous years. During the same period, non-metropolitan enrollment in MA and other prepaid plans increased from 2.1 to 2.2 million enrollees (from 21.2% to 21.8% of eligible beneficiaries). The non-metropolitan growth rate of 5.3% is also significantly lower than that seen in previous years. 

Forging New Paths to Integrate Rural Veterans’ Care Nationwide
One quarter of all veterans in the United States, 5.2 million people, call rural communities home.  Three million of these veterans are enrolled in the US Department of Veterans Affairs (VA) for health care. Most rural veterans (82%) have other health insurance and many of them use it to see community providers in addition to their VA health care professionals. In addition, the Veterans Choice Act of 2014 created new avenues for VA and community health care providers to work together in providing veterans primary and specialty care closer to home. Indeed, community clinical workload for veteran care increased 27% last year. Now more than ever, as VA transforms from its traditional role as direct health care provider to an integrated provider and payer of care, the quality of rural veterans’ health care is dependent upon close relationships between community providers and VA.

Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available. This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of CO-OP products in rural and urban counties and compare the number of products available in counties with and without CO-OP plans in 2014 and 2015. We also examine the proportion of lowest cost silver products for 27 year olds offered by CO-OPs in both years. To better understand the impact of CO-OP closures on consumer choice in the 2016 Marketplaces, we examine how these closures may have affected the prevalence of CO-OP products in rural versus urban counties and overall product availability. 

Community adaptations to an impending food desert in rural Appalachia
This study investigated how a new food desert affected family food acquisition and storage behaviors in a small rural community. Food pricing was a stronger influence on food acquisition behavior than food access, but both should be addressed if the effects of a food desert are to be offset.

Technology Use Among Patients in a Nonurban Southern U.S. HIV Clinic in 2015
The survey study data suggest that Internet access among nonurban and rural patients with HIV is adequate to support trials testing Internet-delivered interventions. It is time to develop and deliver Internet interventions tailored for this often isolated subpopulation.

Early elective delivery and vaginal birth after cesarean in rural US maternity hospitals
This article describes the policies on early elective delivery and vaginal birth after cesarean in rural maternity hospitals in the US. Further research is needed to support implementation of national recommendations in a variety of rural and urban hospital settings.

Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
Analyzes the relationship of rurality, geographic location, economic factors, and the availability of health resources, with home healthcare outcomes among rural Medicare beneficiaries at high risk for hospital readmission and emergency department use.

Health Insurance CO-OPs: Product Availability and Premiums in Rural Counties
Describes the role of CO-OPs, their regional distribution, and national prevalence in rural and urban counties, and compares the number of products available in counties with and without CO-OP plans in 2014 and 2015.

The Impact of State Health Policies on Integrated Care at Health Centers
Examines the opportunities and challenges at the federal, state, payer, and provider levels regarding the adoption of an integrated healthcare model focusing on the coordination of medical care and behavioral health in rural and urban community health centers (CHCs). Describes specific state initiatives that have supported or inhibited this coordinated approach.

Rural Behavioral Health: Telehealth Challenges and Opportunities
Reviews the barriers to mental and substance use disorder treatment and services in rural communities, presents ways telehealth can address these barriers, and discusses the challenges in implementing telehealth services in rural areas.

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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
February 5-8: Rural Healthcare Leadership Conference - Phoenix, AZ
February 7-9: 28th NHRA Rural Health Policy Institute​ - Washington, DC

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Resources

Rural Health IT Workforce Program Curriculum Resources
From 2013-2016, 15 Rural Health IT Workforce grantees were supported by FORHP to focus on activities related to the recruitment, education, training, and retention of health IT specialists. A website has been created on the RHIhub website that includes a complete inventory of curriculum resources, including detailed course descriptions and training materials. The resources can be used as examples for rural and rural serving communities, vocation, and technical colleges that wish to offer similar trainings in their educational institutions. Educators are encouraged to use and adapt the information provided. 
 
Direct Links to the Webpages for the RHITW Curriculums: 


Child Care Deserts
A report analyzing child care centers by zip code in eight states (including Virginia), with a specific focus on how limited or complete lack of access disproportionately affects rural areas. Includes a discussion of what constitutes a child care desert and what may prevent families from finding needed care, such as prohibitive cost based on income ratio.

Tobacco Use Control Program (TUCP)
TDH toolkits available for organizations who are interested in becoming tobacco free worksites! The TUCP Regional Coordinators can provide technical assistance and policy analysis to organizations as well as signage. Tobacco use among employees has shown to negatively affect productivity and absenteeism, along with an increase in employee sick time, disability leave, and health care costs. Make your worksite healthier and more productive!

How to Help a Loved One with Diabetes When You Live Far Apart
A resource you can provide for those patients who need additional help and for those trying to care for a loved one living far away. 

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Funding Opportunities

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

Garrett Lee Smith (GLS) Campus Suicide Prevention Grant
The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services is accepting applications for fiscal year (FY) 2017 Garrett Lee Smith (GLS) Campus Suicide Prevention grants. The purpose of this program is to facilitate a comprehensive public health approach to prevent suicide in institutions of higher education. The grant is designed to assist colleges and universities in building essential capacity and infrastructure to support expanded efforts to promote wellness and help-seeking of all students. Additionally, this grant will offer outreach to vulnerable students, including those experiencing substance abuse and mental health problems who are at greater risk for suicide and suicide attempts.
Deadline: December 7

Virginia Service Foundation 
The Virginia Service Foundation offers mini-grants throughout the year to any public or private nonprofit organization, serving the Commonwealth of Virginia, including faith-based and other community organizations, public or private schools, institutions of higher education and government entities. Qualifying organizations may be eligible for an award to use towards hosting a service project for the following National and Regional Service Initiatives: Day to Serve, 9/11 Day of Service and Remembrance and MLK Day.

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