VRHA Weekly Update
In this Issue  June 26, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


June Newsletter



Student Scholarships - Present for VRHA!

VRHA is inviting students who are in any health or public policy program to submit essays on why they want to serve rural communities.  Five essays will be selected and the authors will receive free conference registration.

The author of the winning essay will have the honor of reading the essay during the Rural Health Providers Conference and will receive 2 complimentary nights at Berry Hill Resort and free conference registration.

Download the scholarship form here.

Completed forms must be e-mailed to boconnor@vcom.vt.edu on or before September 8.  Winners will be announced on September 15th.

Click the conference logo to the right
to learn more about the event.

October 25 & 26
South Boston, VA 

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Members in the News

By Jenny Tate - Coalfield Progress

[VRHA member] Dickenson Community Hospital and Dickenson County Behavioral Health will be part of a five-year effort aimed at improving the health of Medicare and Medicaid beneficiaries. In an announcement, Mountain States Health Alliance said it is one of only 32 organizations in the country that were chosen to be part of the U.S. Centers for Medicare & Medicaid Services’ new program.

Along with the Dickenson County facility and organization, other in the collaborative include Cumberland Mountain, Highlands and Mount Rogers Community Services Boards, Frontier Health, Planning District One Behavioral Health Services, eight inpatient facilities and 12 physician offices of Mountain States and five inpatient facilities and 15 physician offices of Wellmont Health System.

The participating Mountain States facilities are Dickenson Community Hospital, Indian Path Medical Center, Johnson City Medical Center, Johnston Memorial Hospital, [VRHA member] Norton Community Hospital, [VRHA member] Russell County Medical Center, [VRHA member] Smyth County Community Hospital and Woodridge Psychiatric Hospital.

Read the full article.

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More Members in the News

By Audrey Thomasson - Rappahannock Record

Two years after taking over [VRHA member] Rappahannock General Hospital (RGH) and promising to expand services, Bon Secours is closing down two key areas—the intensive care unit (ICU) and surgeries.

“Decisions are not made off of profits,” said John Michael Wallace, public relations manager for Bon Secours in Richmond. “They’re made off of patient volume. Patient volumes, critical care access and community health needs are factors in determining service offerings…and in making the changes.”

Read the full article.

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Virginia News

A Message from Secretary Hazel

By Secretary Bill Hazel - Richmond Times-Dispatch

As an Orthopedic surgeon for more than two decades, I’ve long honored my Hippocratic Oath to “do no harm.” It would be wise for our nation’s leadership in Washington to do the same.

Unfortunately, President Donald Trump’s recent budget proposal will force our commonwealth to make impossible choices that will hurt Virginians from all walks of life.

His proposed budget slashes federal Medicaid spending by $627 billion, in addition to the draconian $880 billion cut in the AHCA bill that passed the U.S. House of Representatives. The Congressional Budget Office says the AHCA will result in 23 million people losing their insurance.

Together, these cuts will harm millions of low-income Americans, primarily children, seniors and people with disabilities. The budget proposal also reduces federal support for school health programs, community mental health providers, social services and more.

Virginia’s current Medicaid program provides coverage to the fewest people required by federal law. We have no more room to cut. Doing so only threatens to harm our most vulnerable neighbors, including our youngest generation.

Read the full article.

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The Free Clinic Myth

By Chad Stewart - Commonwealth Institute

During this recent legislative session, lawmakers argued over an amendment that would have effectively led to Medicaid expansion later this year. Lawmakers against expansion noted that the state already has a safety-net for those without health coverage. It’s called free clinics. These lawmakers chose to employ the following logic to their arguments: the legislature recently increased state funding for free clinics, the system works very well as a safety-net, and therefore expansion is not necessary.

The reality is that there is no equivalency between these two essential safety-net programs – given the vast disparities in scale and scope of the services provided by each.

While free clinics do an outstanding job providing vital services to 75,000 low-income uninsured adults each year in Virginia, Medicaid expansion could provide continual coverage to hundreds of thousands of  low-income Virginians – allowing many to see primary care physicians for the first time and seek preventative services instead of emergency care. Many free clinics are stretched to their limits throughout the state, have long waiting lists, and have to employ lottery systems for patients to receive essential care. 

Read the full article.

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Better Access but High Poverty

By Dan Heyman - Public News Service

More Virginia children are getting healthcare coverage, according to the 2017 KIDS COUNT Data Book. But the state is struggling with a stubbornly high number of kids in poverty.

According to the report, 95 percent of the states' children now have access to healthcare, many through Medicaid or FAMIS, the state's CHIP program. But, Beth Nolan, KIDS COUNT director at Voices for Virginia's Children, says in spite of the economy now gradually recovering, one-sixth of the state's children still live in poor households.

"There's still one in every six children who live in poverty," she laments. "And what's startling is that, while the United States has actually seen a five-percent decline in the number of children living in poverty, Virginia has seen a seven-percent increase."

In the new report, Virginia moved up one spot in the rankings for overall child well-being, from 11th in the nation to 10th.

Read the full article.

Beyond Blue

Paul Collins - Martinsville Bulletin

The Virginia Health Care Foundation - the public/private partnership helps uninsured Virginians who live in underserved communities receive mental health, medical and dental care - has launched a $1.5 million initiative, called Beyond Blue, will have a three-pronged approach, according to a foundation statement.

The initiative will address mental health needs in the health-care safety net by integrating behavioral health services with primary medical care for diabetic patients with depression; preparing interested health-care safety net organizations to implement a trauma-informed approach to care in their practices with a focus on resiliency training; and increasing the number of psychiatric nurse practitioners educated and practicing in the health-care safety net and Virginia.

A health-care safety net includes such organizations as community health centers, free and charitable clinics, health departments and hospitals that help people who can’t get health care.

Read the full article and a related article from the Richmond Times-Dispatch.

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National News

Rural Tobacco

By William Wan - Washington Post
After decades of lawsuits, public campaigns and painful struggles, Americans have finally done what once seemed impossible: Most of the country has quit smoking, saving millions of lives and leading to massive reductions in cancer.

That is, unless those Americans are poor, uneducated or live in a rural area. 

Debbie Seals, 60, has fought on the front lines of this new class battle for the past six years from her home in the rural foothills of Virginia’s Blue Ridge Mountains. She has driven her tiny blue Fiat to the farthest corners of southern Virginia and West Virginia to hold classes aimed at helping smokers quit. Her cessation clinics are often the only ones offered for miles around.

In her home town of Martinsville, Va., cigarettes are ubiquitous. People smoke on their morning drive to work and on weekends mowing their lawns. Tobacco stores line the strip malls, and cigarette ads are in the windows of every gas station and convenience store.

Read the full article.

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Pain and the Opioids Crisis

By Sarah Kliff - Vox

Williamson, West Virginia is a town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.
On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you’d expect.
“Elderly folks who depend on blood pressure medications, who can’t afford them, they’re selling their [painkillers] to get money to buy their blood pressure drug,” Williamson fire chief Joey Carey told me when I visited Williamson. “The opioids are still $5 or $10 copays. They can turn around and sell those pills for $5 or $10 each.”
Opioids are everywhere in Williamson, because chronic pain is everywhere in Williamson.

Read the full article.

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Rural Publications

Examination of cardiovascular risk factors and rurality in Appalachian children
This article examines cardiovascular disease risk factors in children and adolescents in West Virginia. Contrary to previous literature suggesting a straightforward link between rurality and cardiovascular risk factors, the authors found mid-sized metropolitan areas presented with the highest risk, and recommend future longitudinal studies to explore mechanisms between cardiovascular risk factors and rurality.

Residing in Economically Distressed Rural Appalachia is Independently Associated with Excess Body Weight in College Students
Results of a study comparing body weights and obesity risks of college students aged 18-25 years, 55 of whom who were lifelong residents of rural Eastern Appalachian Kentucky and 54 from urban central Kentucky. Features statistics including age, education, gender, race or ethnicity, insurance status, household income, and health behaviors, with breakdowns by rural or urban status.

Prevalence of Arthritis and Arthritis-Attributable Activity Limitation by Urban-Rural County Classification — United States, 2015—in the May 26 edition of the Morbidity and Mortality Weekly Report (MMWR). It found that rural communities are hard hit by arthritis, where a third of adults living in rural areas have arthritis and that over half of adults with arthritis in rural areas are limited by the condition.

Translating agricultural health and medicine education across the Pacific: a United States and Australian comparison study
Agricultural communities have unique healthcare requirements owing to the high rate of workplace deaths, preventable injuries and illness. They typically also have limited access to services. To address these needs, the University of Iowa, USA, established a course in agricultural medicine, which has since been adapted for Australian students. This article reviews the educational and practice outcomes of students who have completed the agricultural medicine course in Australia and the USA.

Learning by doing: the MD-PA Interprofessional Education Rural Rotation
In this short communication, the authors describe an innovative approach to IPE for medical students and physician assistants in the clinical setting. Reflections from a pair of students highlight the potential value of a concurrent clinical placement.

Building a community of practice in rural medical education: growing our own together
This article examines the history of rural training track residency programs in the United States over the past 30 years. This account reveals the significance of a community of practice for ongoing support and development of these programs.

Developing a grounded theory for interprofessional collaboration acquisition using facilitator and actor perspectives in simulated wilderness medical emergencies
This project report describes how simulated medical scenarios were used to improve collaboration among wilderness medicine professionals. The authors present sharing as a core concept of a grounded theory with application for interprofessional education, particularly relevant to rural and remote contexts.

Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study
This article describes the use of in-depth qualitative interviews with healthcare professionals to examine opportunities and challenges in promoting CRC screening in rural areas. Findings suggest opportunities to increase rates through alternative healthcare delivery models such as accountable care organizations.

Issues Confronting Rural Pharmacies after a Decade of Medicare Part D
The financial viability of small rural pharmacies became a concern following the advent of Medicare Part D in 2005. Previously receiving payment directly from Medicare based on charges, pharmacies now are reimbursed by private insurance plans per the terms of contracts offered by those plans. There was a significant increase in the number of rural pharmacies that closed following the implementation of Part D, but that rate of closures has moderated in recent years. This brief assess the issues that threaten the sustainability of small rural pharmacies after more than 10 years of experience with Medicare Part D. 

Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties
Access to obstetric care in rural communities is critical to ensuring good maternal and child health outcomes. Although over 28 million reproductive-age women live in rural U.S. counties, 43% of rural counties in the U.S. had no hospital-based obstetric services in 2002. Media coverage and reports since then have indicated that the number of rural hospitals providing obstetric care has been decreasing; however, the national scope of these access problems has not been quantified. 


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Mark Your Calendar

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

June 27: Cyber Insurance: Tangible Risks and Virtual Coverage - webinar
June 28: Report on Lessons Learned from Rural Opioid Overdose Grant Recipients - webinar
July 6: Reporting Preventive vs Problem Oriented Services for RHC and FQHC  - webinar
August 16: A Focus on Suicide Prevention in Rural Communities  - webinar
October 25 & 26: Virginia Rural Providers Conference - South Boston, VA

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Rural Health Fellows Program
A year-long, intensive program designed to develop a community of rural health leaders.
Application Deadline: Sep 1, 2017

COPD National Action Plan
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States, with a higher prevalence of the disease in rural communities.  At the end of May, the National Institutes of Health, in collaboration with representatives from across the COPD community, released the first ever COPD National Action Plan providing a unified framework for reducing the burden of the disease.  To get involved, read more about the plan’s goals and download resources for outreach on the National Heart, Lung and Blood Institute website.

Guide to Selecting Population Health Management Technologies for Rural Care Delivery
This guide is a six-step process to plan for and implement technology to manage the health of existing patient populations. A key resource within the guide is Population Health Software Capabilities which helps organizations understand and prioritize the capabilities of population health software. 

Chronic Care Management FAQ Sheet
Beginning on January 1, 2016, RHCs and FQHCs may receive payment for CCM services furnished to Medicare beneficiaries having multiple (two or more) chronic conditions that are expected to last at least 12 months or until the death of the patient, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

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Funding Opportunities

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

Rural Hospital Leadership Award
Provides an educational stipend to a small or rural hospital administrator or chief executive officer to attend an AHA Annual Meeting or Health Forum Leadership Conference.
Application Deadline: Aug 11, 2017

Foundation for Rural Service Grant Program
Provides grants for rural communities in the areas of business development, community development, education, and telecommunications.
Application Deadline: Sep 15, 2017

Empowered Communities/Healthier Nation
This program from the U.S. Department of Health & Human Services targets rural and urban communities disproportionately impacted by the opioid epidemic and seeks to develop community-level strategies for prevention and increasing access to treatment and recovery services.  The strategies should include collaboration among local public health, law enforcement, substance abuse assistance providers and the medical community to provide comprehensive services.  State and local governments, Native American tribal governments, institutions of higher education and small businesses are among those eligible to apply for awards of up to $350,000.   For more information, contact Sonsiere Cobb-Souza 
Deadline: July 31

Rural Community Development Initiative
USDA’s Rural Development office also expects to award 25 grants, each ranging from $50,000 to $250,000 to private, nonprofit and public organizations providing financial and technical assistance for housing, facilities and economic development in rural communities.  Successful applicants will be required to provide matching funds in an amount at least equal to the RCDI grant.
Deadline: July 25

Building Communities of Recovery
The Substance Abuse and Mental Health Services Administration expects to make 13 awards of up to $200,000 each to increase the availability and quality of Recovery Community Organizations (RCOs). RCOs are nonprofit organizations such as Narcotics Anonymous or SMART Recovery that provide long-term support and counseling, in peer group settings, for recovery from substance abuse and addiction. Grantees will use funds to build connections with other RCOs and reduce the stigma associated with addiction through public education and outreach efforts. 
Deadline: July 3, 2017

Faculty Loan Repayment Program (FLRP)
Health professionals who are U.S. citizens from a disadvantaged background may be eligible to receive payment assistance for their educational loans in exchange for a two-year commitment on the faculty of a health professions school.  FLRP supports the next generation of the health workforce by recruiting degreed professionals to pursue faculty roles in their respective health care fields.  Health care workforce with cultural understanding of the patients they serve is particularly important in rural areas, where it’s more difficult to recruit and retain professionals.
Deadline: June 29

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Virginia Rural Health Association
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Blacksburg, VA 24060

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