Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue January 19, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available





Rural Health Works!

VRHA is partnering with the National Center for Rural Health Works to provide a webinar series on the economic impact of healthcare in rural communities.  Tentative schedule is:

  • February 26: Impact of a Small Rural Hospital or Critical Access Hospital
  • March 26:  Impact of a Rural Health Network
  • April 30: Impact of a Community Health Center (FQHC) or Rural Health Clinic
Details and registration coming soon.

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New Advocacy Tool

The Commonwealth Institute released a new report today that shows district-by-district analysis on the number of Virginians who could benefit from closing the coverage gap. This is new and important information.

Whereas prior analysis was limited to locality, this analysis uses newly released Census data to go deeper and look specifically at legislative districts. This information is directly on point to the concerns of lawmakers when it comes to the needs of the people in their districts.

VRHA urges you to make the most of this new analysis: send an action alert to your members; submit an op-ed or a letter to the editor in your local paper; contact or write to your elected officials; use the numbers from the report and ask them to help their constituents in their districts get the coverage they need. 

VRHA is available to provide technical assistance with drafting talking points, helping with your letters and opinion pieces, and anything else that would help you with your advocacy on this issue. Please feel free to contact Beth O'Connor if you have any questions.

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Members in the News

By Elizabeth Simpson - The Virginian-Pilot

It's a scenario playing out across the country, as more people with disabilities are living in communities instead of institutions such as nursing homes and state facilities for disabled people.  Dentists don't want to take the chance of doing that type of work outside a hospital, and dentists with hospital privileges are hard to come by.

[VRHA member] Virginia Oral Health Coalition has identified the shortage and recently partnered with residential homes and dental schools to train dental providers in Virginia to treat people with special needs.

Read the full article.

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Virginia News

Legislative Watch

Recently introduced legislation who could impact health and health care in rural Virginia:

HB 1509 Hospitals; required notice to patients. quires hospitals to provide oral and written notice to any patient that has been placed in observation or outpatient status that he has been placed in such status if (i) the patient receives onsite services from the hospital and (ii) such onsite services include a hospital bed and meals that are provided in an area of the hospital other than the emergency department. 

HB 1564 Schedule I drugs.  Adds N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)indazole-3-carboxamide (other name: AB-CHMINACA), N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)indazole-3-carboxamide (other name: 5-fluoro-AMB), and 3,4-methylenedioxy-N,N-dimethylcathinone (other names: Dimethylone, bk-MDDMA) to Schedule I of the Drug Control Act, in accordance with the action of the Board of Pharmacy adding these substances to Schedule I pursuant to § 54.1-3443. 

HB 1747 Health insurance; mental health parity.  Conforms certain requirements regarding coverage for mental health and substance use disorders to provisions of the federal Mental Health Parity and Addiction Equity Act. The measure requires that group and individual health insurance coverage shall provide mental health and substance use disorder benefits. Such benefits shall be in parity with the medical and surgical benefits contained in the coverage in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008, even where those requirements would not otherwise apply directly. The measure requires any health insurer whose policy, contract or plan provides coverage for mental health and substance use disorder benefits to provide to the Bureau of Insurance information regarding the rates at which claims for mental health and substance use disorder benefits are denied under each policy, contract, or plan it provides.

SB 1227 Telemedicine services; prescriptions. Amends the definition of telemedicine services to encompass the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient, consulting with other health care providers regarding a patient's diagnosis or treatment, or transmitting a patient's health care data. The measure also provides that an examination performed using telemedicine services shall be sufficient to meet the requirement for an "appropriate examination" and states that if a telemedicine services practitioner prescribes medication other than Schedule VI controlled substances to a patient, at least one in-person physical examination must have occurred. 

SB 1265 Acute psychiatric bed registry; frequency of updating. Requires state facilities, community services boards, behavioral health authorities, and private inpatient psychiatric service providers to (i) update information included in the acute psychiatric bed registry whenever there is a change in bed availability for the facility, board, authority, or provider and (ii) review information included in the acute psychiatric bed registry for accuracy at least once daily. 

HB 1833 Naloxone; administration by law-enforcement officers. Allows law-enforcement officers to possess naloxone and administer naloxone to a person who is believed to be experiencing or about to experience an opiate overdose. The bill provides law-enforcement officers immunity from civil liability for any personal injury that results from the good-faith administration of naloxone

HB 1841 Prescription Monitoring Program; requirements for dispensers. Requires every prescriber who is authorized to prescribe covered substances and every dispenser to be registered with the Prescription Monitoring Program and allows prescribers and dispensers six months to comply with the registration requirement; provides that a prescriber shall request information about a recipient any time the prescriber prescribes a 90-day supply of benzodiazepine or opiate, regardless of whether a treatment plan has been entered into; requires a dispenser registered with the program to request information about covered substances that have been dispensed to a patient when the dispenser is dispensing benzodiazepines or opiates expected to last more than 90 days; and authorizes the Director the Department of Health Professions to disclose information about a specific recipient to a dispenser for the purpose of establishing a prescription history to assist the dispenser in determining what, if any, other covered substances have been dispensed to the patient.

HB 1956 Hospitals; patients who are deaf or hard-of-hearing. Requires the Board of Health to include in regulations governing hospitals a provision that each licensed hospital (i) develop a process for identifying patients who are deaf or hard-of-hearing and (ii) take steps to ensure that patients who are deaf or hard-of-hearing are able to effectively communicate with health care providers involved in their care. 

SB 1186 Naloxone; administration in cases of piate overdose. Allows a practitioner to prescribe naloxone to a patient for administration to a person other than the patient when the patient believes the person is experiencing or is about to experience a life-threatening opiate overdose and allows a person to possess naloxone and administer naloxone to a person experiencing or about to experience a life-threatening opiate overdose. The bill provides that under such circumstances (i) a person who administers naloxone to another person shall not be liable for civil damages and (ii) a prescriber shall not be civilly or criminally liable for injuries resulting from the prescription of naloxone to a patient for administration to another person. The bill also allows emergency medical services personnel and other first responders to possess and administer naloxone pursuant to a written order or standing protocol, and the bill provides that first responders and emergency medical services personnel who administer naloxone pursuant to a written order or standing protocol shall not be civilly or criminally liable for injuries resulting from the administration of naloxone. 

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Country Doctor of the Year

By Tammie Smith - Richmond Times-Dispatch

Dr. John Otho “Rob” Marsh III has tended to soldiers wounded in battle but finds that practicing medicine in a rural area has its own challenges. His dedication to his patients in the small town of Middlebrook in the Shenandoah Valley has earned him an award as “country doctor of the year” by a national physician staffing firm.

“He is one of the few primary care physicians in our community that still admits (patients) to the hospital, meaning he follows his patients from their home setting, to his physician office practice, to the hospital, back home or to the nursing facility.”  said Mary Mannix, chief executive officer of Augusta Health, a 255-bed community hospital that serves the region where Marsh practices. Marsh is on the hospital’s board of directors.

A Virginian has won the prize previously. In 2006, Dr. David Nichols of White Stone was honored. For more than 30 years Nichols made weekly trips to tiny Tangier Island in the middle of the Chesapeake Bay, piloting a small plane or helicopter to get there, to provide care to the island’s 500 or so residents. He died in 2010.

Read the full article.

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Close to Home

By John Beifuss - the Commercial Appeal

Directed by Jeff Reichert and Farihah Zaman, (the movie) “Remote Area Medical” celebrates the efforts of the title agency by chronicling a three-day initiative in April 2012, when RAM volunteers traveled to “the heart of Appalachia and the Birthplace of Country Music” to set up shop inside the Bristol Motor Speedway in East Tennessee. There, they provided free medical, dental and eye care to hundreds of people, many of whom had arrived days ahead of time, sleeping in their cars to ensure an appointment and more or less “tailgating” as they awaited ear wax extraction and X-rays of spotted lungs.

There’s a certain irony to the spectacle of seeing all these needy people gathered inside the huge stadium (capacity: 160,000) for the most private and personal of experiences: They’re here to have their teeth pulled by dentists rather than rattled by NASCAR engines, and to have their eyes fitted for glasses rather than startled by feats of racetrack derring-do.

There’s a sadness as well: The Knoxville-based RAM was founded in 1985 to bring medical care to the Amazon, but today more than 60 percent of its volunteer-run clinics operate in the U.S. “We’ve cut back in places like Guatemala, Honduras, Dominican Republic, Africa, simply because we’re overwhelmed with the need here,” says RAM founder Stan Brock.

Read the full article and view a clip of the movie.

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National News

CAH Relief Act

By Erin Mahn - National Rural Health Association

Representatives Adrian Smith (R-NE), Greg Walden (R-OR), David Loebsack (D-IA) and Todd Young (R-IN) have introduced the H.R. 169, the Critical Access Hospital Relief Act. This bill would eliminate the current Condition of Payment requirement that physicians at Critical Access Hospitals certify, at the time of admission, that Medicare and Medicaid patients will not be at the facility for more than 96 hours.

This important legislation will go far in helping alleviate unnecessary red-tape for Critical Access Hospitals throughout the nation.  NRHA commends these rural health champions for their leadership and encourages Congress to act quickly to pass this legislation.


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Rural Practices Move Ahead

By Brian Whitacre - the Daily Yonder

After years of lagging metropolitan areas in adopting electronic medical records, rural practitioners have jumped ahead in the use of the computer-based record-keeping system. A newly published study shows that 56% of rural medical practices have adopted electronic records, while only 49% of metropolitan practices have done so. The findings counter broadly held assumptions that rural areas always lag urban ones in the adoption of new technology.

The reasons for rural practitioners’ quicker acceptance of computer-based medical record keeping could be the unique characteristics of rural practices (such as more Medicare and Medicaid patients) or changes in the data products available to rural practices. Or it might be the result of an innovative government program that helps practices learn to use electronic records.

The impact of these programs on practices – particularly those in rural locations – has been dramatic.  As of 2012, and for the first time, practice-level EMR adoption rates in rural areas outpaced those in urban areas (56% to 49%), according to the study.  This represents an impressive shift from earlier studies that showed rural doctors significantly lagging their urban counterparts.

Read the full article and a related article from NPR regarding the prohibitive costs of EHRs for rural practices.

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Telemedicine Blocked

By Jayne O'Donnell - USA TODAY

Videoconferencing doctors from other areas could help solve the problem of hospital closings and doctor shortages that hit heavily rural states, but proponents say states move too slowly in allowing it. This practice of telemedicine has been caught in a conflict between insurers, doctors and officials reluctant to allow physicians who haven't seen a patient in person — and may never follow up — prescribe drugs or treatment.

Nearly 30 states don't allow reimbursement for video visits, which keeps doctors from practicing telemedicine. There's no organized opposition to the practice — the American Medical Association endorsed it in June — but state legislatures and medical boards have been slow to change rules and laws to allow it.

Alabama, Arkansas, Missouri, Nebraska and Texas are the most restrictive when it comes to patients in rural areas being treated by a doctor on video whom they haven't met in person, according to a study by the American Telemedicine Association, which supports expanding the practice.

Read the full article.

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Rural Overhaul

By John Commins - HealthLeaders Media

Rural healthcare delivery doesn't need to be tweaked. It needs an overhaul. Even after years of talk and studies and calls for reform, most healthcare delivery in rural American remains overly reliant upon small hospitals with limited resources that provide fee-for-service inpatient sick care.

Care coordination, community outreach, and wellness and prevention programs often don't get the money or the emphasis they deserve because hospital leaders with immediate budgetary concerns aren't reimbursed for them.

We have well-intentioned rural hospital leaders and other providers who are ready and willing to act, but who are constrained by lack of money and other resources and must continue operating under an antiquated care delivery system.

Read the full article.

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar
February 3-5: Rural Health Policy Institute - Washington, DC
March 29-31: Shaping the Future of Healthcare through Innovation and Technology - White Sulphur Springs
April 8-9: Virginia Forum on Youth Tobacco Use - Richmond

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The Pharmacy Connection​
Web-based software program created by VHCF that helps provide prescription medications to chronically ill, uninsured individuals throughout Virginia and in selected other states.

The Role of Graduate Medical Education in the New Health Care Paradigm 
The report describes how graduate medical education (GME) must provide physicians with the skills and attributes they will need to achieve high quality patient care in the settings and systems of a changing practice environment.

Best Practices for Health Insurance Marketplace Outreach and Enrollment  in Rural Areas
Guidelines developed by the North Carolina Rural Health Research program.

Training Health Professionals in Community Settings During a Time Of Transformation: Building And Learning In Integrated Systems Of Care. 
The 11th report of the ACTPCMD aims to integrate principles of interprofessional education with the building of community-based collaborations and partnerships in primary care practice.  A transformed healthcare system will be one grounded in primary care practice based on interprofessional teams practicing within learning organizations that facilitate patient engagement, engage in continuous quality improvement, measure outcomes, and are at the center of their medical neighborhood.  

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Funding Opportunities

United Way - Thomas Jefferson Area Impact Grant
Funding for programs focused on school readiness, self sufficiency and community health.

Community Connect Broadband Grant Program
Application deadline: Feb 17, 2015
Grants for communities without broadband service to provide residential service and connect facilities such as police and fire stations, healthcare, libraries and schools. Priority will be given to rural areas that have the greatest need.
Sponsor: USDA Rural Utilities Service

Primary Care Training and Enhancement (PCTE)
Application deadline: Feb 18, 2015
Awards funds to support enhanced training for future primary care clinicians, teachers, and researchers while promoting primary care practice in rural and underserved areas.
Sponsor: Bureau of Health Workforce 

Nurse Anesthetist Traineeship Program (NAT)
Application deadline: Feb 26, 2015
Provides funding to support traineeships for licensed nurses who are enrolled in a nurse anesthesia program, with preference given to projects that will benefit rural and underserved populations.
Sponsor: Bureau of Health Workforce 

Primary and Behavioral Health Care Integration (PBHCI)
Application deadline: Feb 27, 2015
Funding to provide coordinated and integrated services through the co-location of primary and specialty care services in community-based mental and behavioral health settings.
Sponsor: Substance Abuse and Mental Health Services Administration

Geriatric Workforce Enhancement Program
Application deadline: Mar 5, 2015
Provides funding to establish and operate geriatric education centers that will work to equip the primary care workforce with the knowledge and skills to care for older adults, and develop a healthcare workforce that will seek to include patient and family engagement by integrating geriatrics with primary care.
Sponsor: Bureau of Health Workforce

AstraZeneca HealthCare Foundation: Connections for Cardiovascular Health
The mission of the AstraZeneca HealthCare Foundation's program, Connections for Cardiovascular HealthSM, is to improve cardiovascular health within the United States. Through the program, grants of $150,000 to $180,000 are awarded to U.S.-based nonprofit organizations for initiatives that address patient cardiovascular health issues, work to address unmet needs related to cardiovascular health in the community, respond to the urgency around cardiovascular health issues, and improve the lives of patients and non-professional caregivers in connection with the services provided. In addition, initiatives should be focused on measurable results and the recipient organizations must be able to demonstrate sustainability of their programs after the Foundation grant funds are expended. Applications will be accepted from February 2 through February 26, 2015, at 5 pm ET


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Virginia Rural Health Association
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Blacksburg, VA 24060

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