Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  April 11, 2016 
VRHA News
Virginia News

National News
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VRHA News

Members in the News

By Robert Burke - Virginia Business

Leaders of Virginia’s hospitals are frustrated, and they have some good reasons for feeling that way. After all, they were left hanging when the 2010 Affordable Care Act cut Medicare reimbursements to hospitals in anticipation of Medicaid expansion, but then Virginia refused to expand its program.

Then there were more Medicare cuts in the 2013 sequestration budget deal. According to the Virginia Hospital and Healthcare Association (VHHA), overall funding cuts will cost Virginia hospitals close to $1 billion annually by 2021. “This is not a sustainable business model,” says Sean Connaughton, VHHA’s president and CEO.

Some hospitals are feeling the pinch for reasons that reflect their own more specific circumstances as well as cuts in federal dollars. Valley Health System operates four of its six hospitals in Virginia, and three of them [all VRHA members] — Page Memorial Hospital, Shenandoah Memorial Hospital and Warren Memorial Hospital — were in the red in 2014. That’s better than 2013, though, when all four of its Virginia hospitals failed to break even. 

Read the full article.

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More Members in the News

By Linda Burchette - SWVA Today

[VRHA member] Southwest Virginia Community Health Systems will benefit from a $325,000 federal grant to fight drug addiction. Bryan Haynes, executive director of SVCHS, said the grant will mean that Saltville and the other three medical centers in the system – Meadowview, Tazewell and Twin City in Bristol -- will be able to offer substance abuse counseling as well as medications to help clients fight their addictions.

The new program will focus on treatment for abuse of opioids such as heroin and prescription drugs, including oxycodone and hydrocodone. Haynes said the program will have a behavioral health component with individual and group therapy in conjunction with prescription medication to help with the addiction problem.

Read the full article.

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Even More Members in the News 

By Erin Marshall - Becker's Hospital Review

There's no doubt about it — medical school is expensive. But U.S. News & World Report has compiled a list of 10 private medical schools with the lowest tuition and fees for the 2015-16 academic year. Here are the 10 most affordable private medical schools and their 2015-16 out-of-state tuition rates, according to U.S. News & World Report:
 
1. Baylor College of Medicine (Houston) — $31,663
2. Lake Erie College of Osteopathic Medicine (Erie, Pa.) — $32,985
3. University of Pikeville–Kentucky College of Osteopathic Medicine — $41,320
4. University of Miami Miller School of Medicine — $42,626
5. Edward Via College of Osteopathic Medicine–Virginia campus (Blacksburg, Va.), Carolinas campus (Spartanburg, S.C.) and Auburn (Ala.) campus — $43,250
6. Kansas City (Mo.) University of Medicine and Biosciences — $43,513
7. Lincoln Memorial University DeBusk College of Osteopathic Medicine (Cumberland Gap, Tenn.) — $46,528
8. Touro College of Osteopathic Medicine (New York City) — $48,340
9. Hofstra Northwell School of Medicine (Hempstead, N.Y.) — $48,500
10. Mayo Medical School (Rochester, Minn.) — $49,900

Read the full article.

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Virginia News

Addiction & Mental Illness

By Massey Whorley - Commonwealth Institute

One of the most effective ways to help the 102,000 uninsured, low-income Virginians who also have a drug or alcohol problem or a mental illness is to accept the federal funding to close the state’s coverage gap, according to the latest U.S. Department of Health and Human Services (HHS) report.

Helping people get coverage enables them to get the services they need. In Virginia, people without insurance who have a mental illness or substance use disorder are 32 percent less likely to receive treatment than people with insurance who face the same challenges, according to the report. Although Virginia lawmakers have given some attention to these issues, the state’s restrictive Medicaid eligibility rules leave many without viable options for getting the help they need. One lawmaker who has given this issue his full attention, State Sen. Creigh Deeds, recently noted that closing the coverage gap “would be the single best way to improve mental health care in Virginia.”

Read the full article.

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Rural Route

From EVMS Magazine

This wasn’t the journey she envisioned. She didn’t anticipate becoming Franklin’s only obstetrician, who by now has delivered many of the students at the town’s only elementary school.

Sharon Sheffield, MD (MD ’92, Obstetrics and Gynecology Residency ’97), grew up in Portsmouth and earned her undergraduate degree at U.Va. and her master’s at ODU. She was chief resident at EVMS when an MD student she supervised changed her urban way of life. He suggested that his father, Floyd Clingenpeel, MD, consider hiring Dr. Sheffield for his OB-GYN practice in Franklin — home to about 8,600.

Eighteen years later, Dr. Sheffield is not only an Instructor of Obstetrics and Gynecology at EVMS, she also oversees medical students who choose the new rural elective in obstetrics, the school’s first two-week clinical rotation in rural medicine.

Read the full article.

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Expansion Stops

By Bruce Japsen - Forbes

Momentum seen earlier this year in states led by Republican governors or GOP-dominated legislatures is starting to fizzle as lawmakers wrap up spring sessions.  This means it's increasingly likely that there will be no more state taking advantage of the last year of the health law's generous federal funding formula to expand Medicaid and join 31 states plus the District of Columbia.

A Kaiser Family Foundation tally that tracks Medicaid expansion doesn't have any states considering the option under the ACA "at this time."  The Obama administration has hopes for other states considering like Virginia, which has a Democratic governor, but they continue to be rebuffed by GOP lawmakers when it comes to expanding Medicaid.

After this year, it will cost the states that have balked at expansion more money in the form of a state contribution if they decided to expand after 2016.  Under the ACA, 2016 is the last year states can expand Medicaid programs entirely with federal dollars.

Read the full article.

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National News

Transforming Tragedy 

By Sarah Varney - PBS Newshour

Brad and Sheryl Kott didn’t think much of it seven years ago when their 13-year old son, Quinn, complained his arm felt tingly. But later that day, Mr. Kott found Quinn — a friendly, energetic athlete — on the bathroom floor. His speech was garbled.

After the family arrived at Hill Country Memorial, the local hospital in Fredericksburg, the Kotts say Quinn’s medical care went terribly wrong. Quinn waited in a wheelchair in the emergency room for hours despite his drooping face and slurred speech, and his parents and former hospital administrators say, the ER doctor was inattentive, callous and at a point late in the evening, decided to send Quinn home.

It wasn’t until the next morning that a pediatrician finally examined Quinn. He was rushed to a hospital in San Antonio, about 70 miles south, and died soon after. He had suffered a massive stroke. For Dr. Michael Williams, then Hill Country Memorial’s chief executive officer, Quinn Kott’s death in 2009 was a crucible moment.

Read the full article.

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Mental Health Access

By Justin Haskins - Heartland Institute

In January, President Barack Obama announced a proposal to spend $500 million on improving access to mental health care and to provide better mental health information for firearms background checks.
 
“We must continue to remove the stigma around mental illness and its treatment and make sure that these individuals and their families know they are not alone,” said Obama in a January 4 statement. “While individuals with mental illness are more likely to be victims of violence than perpetrators, incidents of violence continue to highlight a crisis in America’s mental health system.”

While increasing public funding for mental health programs has been one of the more popular policy proposals offered by lawmakers at the national and state levels, existing government regulations on the health care industry may be more to blame for the lack of mental health care services in some parts of the country, especially in rural regions. 

Read the full article.

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Inroads for NPs

By Virgil Dickson - Modern Healthcare

Gail Sadler, a nurse practitioner, provides a wide array of primary-care services at her private practice in Carrollwood, Fla., a community that has been buffeted for years by a physician shortage. But she isn't allowed to write prescriptions for controlled substances—not even cough syrup with codeine. This leaves some of her patients in a difficult spot when they need immediate access to medication.

Advocates' efforts to expand nurse practitioners' duties have only intensified since insurance expansion under the Affordable Care Act began. Nearly 18 million Americans have gained coverage. Moreover, a 2015 Kaiser Family Foundation survey found that more than 58 million Americans reside in areas with primary-care physician shortages.

Read the full article.

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Rural Publications

VA Telemedicine: An Analysis of Cost and Time Savings 
Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients.

Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice
Little is known about how well various types of rural-centric family medicine residency training programs produce physicians for rural practice. This study examined program content and training locations as well as rural and urban practice outcomes for graduates of rural-centric family medicine residency training programs. Though numerous family medicine residencies seek to produce rural physicians, most programs required fewer than eight weeks of rural training. Among those with eight or more weeks of rural training, no single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice. 

Medicare Costs and Utilization Among Beneficiaries in Rural Areas
Ten percent of all Medicare beneficiaries account for 59% of all program expenditures. Although studies have shown that high per-capita spending does not directly correlate with high-quality care, little attention has been paid to where the high-cost areas are in rural communities and what strategies can be used to effectively manage their spending patterns. The purposes of this study were to: 1) assess the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum (i.e., in places where Medicare spending is highest, what services are most likely to be used?); 2) examine the relationships between rural beneficiaries’ service utilization and health care delivery market structure; and 3) evaluate strategies and policies to address high costs in specific rural contexts. 

How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?
New (2014) rural enrollees in the insurance plans available on federal and state exchanges—platinum, gold, silver, bronze and catastrophic plans—are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent (FTE) physicians to provide those visits to new rural enrollees. This study uses data on rural insurance uptake, expected utilization and productivity of physicians, physician assistants (PAs), and nurse practitioners (NPs) to examine how different mixes of physicians, PAs and NPs might be able meet expanding population requirements for care. 

Behavioral healthcare workforce distribution 
Specific attention is needed to improve mental health outcomes in rural communities. Rural communities continue to have higher unmet mental health needs than their urban counterparts. Quantifying workforce supply and shortages can aid in identifying areas in need of the recruitment, training, licensure, and retention of behavioral health professionals. However, workforce analyses have presented a challenge as comprehensive workforce data are limited. This study examines the geographic distribution of behavioral healthcare professionals and the relationship between supply and county characteristics in Nebraska in 2012.

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Mark Your Calendar

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

April 10-12: Mid Atlantic Telehealth Resource Center Annual Summit - Cambridge, MD
April 25-26: National Reduce Tobacco Use Conference - Washington, DC
April 26: Virginia Colorectal Cancer Roundtable - Roanoke
May 10-13: NRHA Annual Rural Health Conference - Minneapolis, MN
June 9: 2016 Health Care Conference - Richmond
July 13-15: Rural Quality & Clinical Conference - Oakland, CA
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO

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Resources

Index for Mortality Rates by Cause Related to the National Rate among Persons by Age, Region, and Rural-Urban Status: United States, 2011-2013
An interactive data visualization Tableau dashboard that displays the mortality rate index by age group, rural-urban status, sex (only for populations 15 years of age and older), and region (Heath and Human Services Regions, Appalachia, Delta). These charts compare mortality rates in subgroups to the national average. Data are presented for the 10 leading causes of death (as reported by the Centers of Disease Control and Prevention) and figures display standardized differences between urban, rural, and national death rates. 

Mortality Rates among Persons by Cause of Death, Age, and Rural-Urban Status: United States, 2011-2013
An interactive data visualization Tableau dashboard that maps mortality rates by age group, rural-urban status, HHS region, and sex (only for populations 15 years of age and older). These maps compare mortality rates in the 10 HHS regions to one another based on rural-urban status. Data are presented for the top 10 leading causes of death as reported by the Centers of Disease Control and Prevention.

Exploring Rural and Urban Mortality Differences by HHS Region (color) | (black & white)
A slide deck that serves as an offline and printable version of the Online Tool: Index for Mortality Rates. It contains 81 figures from the Online Tool displaying mortality rate indices by age group, rural-urban status, HHS region, and sex (only for populations 15 years of age and older). Data are presented for the top 10 leading causes of death as reported by the Centers of Disease Control and Prevention. Figures display standardized differences between urban, rural, and national death rates.  

Exploring Rural and Urban Mortality Differences in the Appalachian Region (color)  (black & white)
A slide deck that serves as an offline and printable version of the Online Tool: Index for Mortality Rates in the Appalachian Region. It contains 9 figures from the Online Tool displaying mortality rate indices by age group, rural-urban status, and sex (only for populations 15 years of age and older) within the Appalachian Region. Data are presented for the top 10 national leading causes of death as reported by the Centers of Disease Control and Prevention. Figures display standardized differences between urban, rural, and national death rates. 

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Funding Opportunities

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

TCE-HIV: Minority Women
Due: April 28, 2016
The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for up to $33 million in Target Capacity Expansion – HIV: Minority Women grants over the next three years. The grant program will expand substance use disorder treatment and HIV services for African American, Hispanic/Latina, and other racial and ethnic minority women. SAMHSA expects that awards of up to $500,000 per year will be provided to an estimated 22 selected grantees for a period up to three years. For information about the new registration and application process for the TCE – HIV Minority Women Grant Program, watch a recording of the pre-application webinar.

Capacity Building Initiative for Substance Abuse (SA) and HIV Prevention Services for At-Risk Racial/Ethnic Minority Youth and Young Adults
Due: April 18, 2016
SAMHSA is also accepting applications for up to $24.4 million for the capacity building initiative for substance abuse and HIV prevention for at-risk racial/ethnic minority youth and young adults. The purpose of this program is to support an array of activities to assist grantees in building a solid foundation for delivering and sustaining quality and accessible state-of-the-science substance abuse and HIV prevention services. SAMHSA expects to fund as many as 19 grantees with up to $257,000 per year for up to five years.  

State Farm Youth Advisory Board: Service-Learning Grants Program
Due: April 29, 2016
The State Farm Youth Advisory Board is composed of young adults who demonstrate exemplary work in service-learning, volunteering, and philanthropy in their communities. The Youth Advisory Board's Service-Learning Grants Program funds student-led service-learning projects throughout the United States. Grant requests must fall under one of the following issue areas: community safety and justice, environmental responsibility, access to higher education/closing the achievement gap, health and wellness, economic empowerment and financial literacy, or arts and culture. Public K-12, charter, and higher education institutions are eligible to apply. Nonprofit organizations are also eligible if they are able to demonstrate how they plan to interact with students in public K-12 schools. Grants range from $25,000 to $100,000. 

Dental Trade Alliance Foundation
Due: May 25, 2016.
The Dental Trade Alliance Foundation is dedicated to supporting promising initiatives that achieve measurable impact and facilitate real change in oral healthcare. The Foundation is offering grants of up to $25,000 for innovative, sustainable, scalable projects designed to increase access to oral healthcare for those in need. Funded projects should not only improve access to oral care in their immediate area, but also have the potential to grow and be implemented in other areas of the country. Applications are accepted from dental organizations, dental schools, universities, government organizations, and nonprofit organizations for programs located in the United States and its territories. (The Foundation is also offering one Foundation/Dental Lifeline Network Grant of up to $25,000 for a project specifically related to providing access to dentistry for individuals with disabilities, or those who are elderly or medically compromised.)

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Virginia Rural Health Association
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Blacksburg, VA 24060
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