VRHA Weekly Update
In this Issue  March 20, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter now available





Members in the News

From WDBJ7

Whether you're having a problem with your ear or your heart, there's usually someone available to treat you at [VRHA member] Blue Ridge Medical Center in Arrington. Blue Ridge Medical Center is what the federal government considers a "community health center," which means it serves people with limited access to health care. For that reason the facility qualifies for additional funding under the Affordable Care Act.

Congress is considering changes to the law but even if nothing happens, the funding Blue Ridge currently receives is scheduled to run out in September.  If the additional funding goes away, chief executive officer, Peggy Whitehead estimates around 2,500 patients who pay lower fees would be impacted. For every three people who come to the center for care and pay a reduced fee, at least one might not be able to continue receiving service.

Read the full article.

See National News for more information regarding proposed federal budget cuts.

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More Members in the News

[VRHA member] Virginia Hospital & Healthcare Association has expressed concern about the American Health Care Act in letters it sent to Virginia’s representatives in Congress. Proposed last week as a replacement to the Affordable Care Act, if approved, the American Health Care Act would most drastically change the Medicaid program and how tax subsidies are doled out to help people afford health insurance.

In the letters, the association’s president and CEO, Sean Connaughton, applauded the fact that the proposed replacement does not change Medicaid to a block-granting system, but expressed concerns about the proposed per capita cap, which would lock Virginia in at what it paid per Medicaid enrollee in 2016.

Virginia is ranked 47th in the nation for per capita Medicaid spending. And because the state did not expand Medicaid, it would be locked in at a much lower rate than other states.

Read the full article.

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Virginia News

ACA by District

By Chad Stewart - Commonwealth Institute

With the recent release of the House Congressional plan to replace the Affordable Care Act (ACA), it’s important to take a look at what the ACA has achieved in Virginia over the past few years and what is at stake from repealing it. Minority staff on the Committee on Energy and Commerce have put out a new report looking at the impact of the ACA in each Congressional District. Like in the rest of the country, the ACA has significantly reduced the uninsured rate in each of Virginia’s 11 congressional districts.

Some highlights from the analysis show that:

  • The drop in the uninsured rate ranges from a low of 1.8 percentage points in the 2nd district (Rep. Scott Taylor) to a high of 5.2 percentage points in the 7th district (Rep. Dave Brat).
  • An average of 34,445 Virginians have gained insurance from the Marketplace in each congressional district.
  • An average of 16,273 Virginians in each congressional district would lose the opportunity to gain coverage from Medicaid expansion if the ACA were repealed without a mechanism for Medicaid expansion in a replacement bill.

All of these gains could be in jeopardy if Congress moves forward with ACA repeal.

See the full article.

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Medicaid Restraint

By Senator Ryan McDougle - Richmond Times-Dispatch

In 2014, Governor McAuliffe was convinced that Obamacare’s Medicaid expansion scheme was essential for Virginia. Desiring to expand the reach of government by increasing entitlements, the governor engineered a budget standoff that brought the commonwealth within two weeks of its first government shutdown.

Now, with Obamacare on life support and its repeal more likely with each passing day, it is those states that accepted Medicaid expansion funds that are facing a crisis. Yet, Governor McAuliffe, like the overwhelming number of elected Democrats, clings to the claim that Obamacare cannot be repealed.

Whether Democrats’ continued support for Obamacare is the result of principle or obstinacy is in the eye of the beholder. Admitting that a policy has failed — particularly one that never gained bipartisan support — is not easy for politicians.

Read the full editorial.

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Close to Home

By Charles Ornstein - ProPublica

As the toll of the opioid epidemic grows, scores of doctors have lost their licenses and some have gone to prison. Pharmacies are being sued and shuttered. Pharmaceutical manufacturers are under investigation and face new rules from regulators. But penalties against companies that serve as middlemen between drug companies and pharmacies have been relatively scarce — until recently.

McKesson Corp., the largest such company in the U.S., last week agreed to pay a $150 million fine. And late last month, Cardinal Health reached a $44 million settlement with the federal government. That’s on top of another $20 million that Cardinal Health agreed this month to pay the state of West Virginia, which has been among the hardest hit by opioid overdoses. Other distributors have also agreed to pay smaller amounts to West Virginia within the past few months. AmerisourceBergen, for instance, will pay $16 million.
“Have the distributors gotten the message? I would hope so,” said Frank Younker, who worked at the DEA for 30 years and retired as a supervisor in its Cincinnati field office in 2014. “The distributors are important. They’re like the quarterback. They distribute the ball. … There’s plenty of blame to go around.”

Read the full article.

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National News


By Erin Mahn Zumbrun - National Rural Health Association

The National Rural Health Association is disappointed that President Trump’s budget calls for a nearly 18 percent, or $15.1 billion, cut to the Department of Health and Human Services. The cuts include funding to the National Institutes of Health, which would decrease by $5.8 billion, and to health professions and nurse training programs, which would decrease by $403 million.

The budget does not provide enough detail to determine how the cuts would affect the rural health safety net, or the budget areas of the Federal Office of Rural Health Policy or the State Offices of Rural Health, which are priorities to NRHA. While the budget does not specify which health professional and nurse training programs would be cut, NRHA is concerned these cuts will impact important rural workforce programs.

NRHA does applaud President Trump for not calling for cuts to Critical Access Hospitals, as President Obama’s budget called for.

Funding for the rural health safety net is more important than ever as rural Americans are facing a hospital closure crisis. Eighty rural hospitals have closed since 2010. Right now, 673 additional facilities are vulnerable and could close—this represents over 1/3 of rural hospitals in the U.S. Continued cuts in hospital payments have taken their toll, forcing far too many closures.  Medical deserts are appearing across rural America, leaving many of our nation’s most vulnerable populations without timely access to care. 

Rural health programs assist rural communities in maintaining and building a strong health care delivery system into the future. Most importantly, these programs help increase the capacity of the rural health care delivery system and true safety net providers.

Programs in the rural health safety net increase access to health care, help communities create new health programs for those in need and train the future health professionals that will care for the 62 million rural Americans. With modest investments, these programs evaluate, study and implement quality improvement programs and health information technology systems.

NRHA asks Congress to support strong funding for these important rural health programs.

And, join NRHA on Wednesday, March 29 at 12 p.m. ET for our March Grassroots call. Learn the latest news from Capitol Hill and the Administration, and get updated on issues affecting rural health, including the latest rural health legislation, regulations, and Committee hearings. NRHA will also provide an analysis of the American Health Care Act.

Registration URL: attendee.gotowebinar.com/register/8120983368487806721

See also a related story in Health Leaders Media.

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Conversation with Nikki King

From Rural Health Leadership Radio

Nikki King is an Administrative Fellow at Margaret Mary Health, a critical access hospital in Batesville, Indiana. She was raised in the coalfields of Central Appalachia, and graduated with a degree in Economics from the University of Kentucky. Nikki has combined her life experiences with formal training to help communicate the challenges facing rural America on both the regional and national stages. Recently, she has done quite a bit of research into the opiate epidemic.

“A lot of the doctors were operating under the information that it was not addictive, or at least not very addictive, so they were giving it out hand over fist, because this was the miracle pain relief, and they got a bunch of people addicted.”

Listen to the full interview.

NOTE: Ms. King was the keynote speaker at the 2016 VRHA Conference.

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Women in Labor

By Julie Lasson - ProPublica

The young woman’s water broke late one morning in August 2014, as she stood in the bathroom of her home in rural Kentucky. Her mother rushed her to the emergency room at Jewish Hospital Shelbyville. She signed a slip at the front desk, listing her chief complaint as “labor.”

But Jewish Hospital had closed its obstetrics department eight years earlier. “We don’t deliver babies here,” the nurse told the woman over the phone, not realizing that she was calling from inside the emergency room, a government inspection found. With no help offered, the woman and her mother went to a nearby gas station and called 911. An ambulance took her to a hospital 24 miles away, where she delivered a baby girl via C-section.

Under the federal Emergency Medical Treatment and Labor Act, or EMTALA, every U.S. hospital with an emergency room has a duty to treat patients who arrive in labor, caring for them at least until the delivery of the placenta after a baby is born. But 30 years after EMTALA was passed, hospitals — particularly those in rural areas without obstetrics units — are still turning away women in labor.

Read the full article.

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Rural Publications

Residing in economically distressed rural Appalachia is independently associated with excess body weight in college students
This study examines obesity in college students living in rural and urban areas of Kentucky. Findings suggest that living in economically distressed rural Appalachia is associated with excess body weight in college students independent of individual-level socioeconomic factors, depressive symptoms, and health behaviors.

Trends in Rural Children’s Health and Access to Care
Federal policies aimed at increasing health insurance coverage among children represent a success story. Due principally to expansions in Medicaid eligibility through the State Children’s Health Insurance Program, the national proportion of children who lack health insurance for an entire year has declined from 13% in 1997 – 1998 to five percent in 2012. Insurance alone, however, may not be sufficient to ensure access among rural children. Many providers, particularly specialists, do not accept Medicaid in addition, rural children have fewer practitioners of all kinds available to them. Finally, the picture of children’s status in the rural U.S. is made more complex by rising diversity in race/ethnicity and increasing poverty. 
For more information, see the Fact Sheet

Women's health care: the experiences and behaviors of rural and urban lesbians
This article reports on the results of a survey of rural lesbians in the United States which assessed access to and experiences with women's healthcare as well as preventative behaviour. Results suggest that rural lesbians experience more health risks than their urban counterparts.

Health care in high school athletics in West Virginia
This study examines how well prepared high schools are to deal with a life threatening emergency during school athletic programs. The authors identify financial and other challenges for rural schools, and recommend training and certification of coaches in the absence of trained healthcare personnel at sporting events.

Integrating Substance Use Disorder Treatment and Primary Care
Policy brief discussing primary care's role in identifying, managing, and treating substance use disorders. Explores state-level options that can be used to strengthen primary care systems such as payment and delivery reform, provider education and training, prescription drug monitoring programs, and medication-assisted treatment. Also examines the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach, and how access barriers may affect SBIRT implementation in rural areas.

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Mark Your Calendar

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

March 22: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Wise
March 24: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Abingdon
March 27: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Martinsville
​March 29: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Richmond
March 29-30: 2017 Population Health Summit - Charlottesville
March 31: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Charlottesville
April 2-4: MATRC Telehealth Summit - Leesburg
May 9-12: 40th Annual Rural Health Conference - San Diego, CA
May 9-12: Rural Hospital Innovation Summit - San Diego, CA

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Model Program: Munson Healthcare Charlevoix Hospital School Nurse Program
Many schools in Michigan do not have school nurses due to budget cuts. Since 2011, the Munson Healthcare Charlevoix Hospital School Nurse Program has brought healthcare to over 3,400 students in 8 rural Michigan schools every year. 

Model Program: Win with Wellness
A multi-component approach of weight-loss support groups and health presentations to help adults in northwest Illinois lose weight and improve their health. 

National Diabetes Education Program Online Resource Center
Provides tools to support your educational programs and activities to help people manage diabetes or prevent type 2 diabetes. Tools include fact sheets, toolkits, booklets, CDs, DVDs, webinars and other materials for a range of groups and individuals, including health care professionals, community-based organizations and individuals, diabetes and health educators, businesses, and people with or at risk for diabetes and their family members. 

A Comparison of Closed Rural Hospitals and Perceived Impact
Compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.

Building Partnerships: Articulating the Value of Care Coordination
Webinar discussing Accountable Communities of Health (ACH) and how to build partnerships to support coordinated care. Includes an explanation and demonstration of the value proposition tool, which helps organizations articulate what the target market really cares about for each product and service. Value proposition worksheet and value proposition canvas diagram also available. 90 minutes.
Additional links: Audio Recording, Presentation Slides, Webinar Recording

CAH Financial Indicators Report: Summary of Indicator Medians by State
Presents state and national median values of 23 financial indicators included in the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). Indicators represent six domains: profitability, liquidity, capital structure, revenue, cost, and utilization. A description of each indicator is provided, and appendix shows median indicator values by state. Indicators are specifically designed to help CAHs compare their financial performance with other CAHs.

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Funding Opportunities

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

Medicare Program: Next Generation Accountable Care Organization (ACO) Model
The Next Generation ACO Model builds upon previous Accountable Care Organization model lessons and will test different risk and financial incentives for ACOs to improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries.
Letter of Intent (Required): May 4, 2017
Application Deadline: May 18, 2017 

AmeriCorps State and National Grants - Targeted Priority
Funding for programs that are designed to strengthen communities and solve local problems, including those found in rural and underserved areas. With this competition, CNCS seeks to prioritize the investment of national service resources in reducing and/or preventing prescription drug and opioid abuse and in strengthening law enforcement and community relations.
Letter of Intent (Optional): Apr 19, 2017
Application Deadline: May 10, 2017 

Healthcare Connect Fund
Provides funding to healthcare providers for telecommunications and Internet access services, as well as network equipment, at a flat discounted rate of 65 percent. Participants can apply as a member of the consortium or a stand-alone entity.
Application Deadline: Jun 30, 2017 

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