VRHA Weekly Update
In this Issue  October 24, 2016

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

VRHA in the News 

By Carmen Forman - Roanoke Times

Candidates for the 9th Congressional District seat discussed Medicaid expansion and the challenges of rural health care Thursday in front of rural health advocates from Southwest Virginia.

U.S. Rep. Morgan Griffith, R-Salem, and Democratic challenger Derek Kitts of Christiansburg separately talked about Southwest Virginia’s long list of health care problems, including opioid abuse, limited access to affordable prescription drugs and the need for more health care professionals in rural areas at a Virginia Rural Health Association meeting.

The health conference was one of the rare occasions this campaign season where the two candidates appeared at the same event, though Kitts and Griffith did not see the other speak because a presentation by the Virginia state health commissioner was sandwiched between them.

Read the full article and related blog.

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Members in the News

By 

The Johnson Health Center and [VRHA member] Blue Ridge Medical Center have received more than $100,000 to upgrade health information technology. The grants are part of $1,468,757 in funding being distributed to 25 health centers in Virginia this month, according to a news release.

The Johnson Health Center, which has clinics in Madison Heights, Bedford and Lynchburg, will receive $60,216, while the Blue Ridge Medical Center in Arrington is set to receive $52,151.

Peggy Whitehead, chief executive officer of the Blue Ridge Medical Center, said Tuesday the center will use the funding to upgrade computers for 14 health care providers and to install an interactive patient education system that can be accessed in every exam room in order to improve patient engagement.

Read the full article.

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More Members in the News

From SWVA Today

[VRHA member] New River Health District, Virginia Cooperative Extension and Family Nutrition Program have created the Vouchers Improve Produce Access (VIPA) program, to help improve food access and community health, with vouchers redeemable for fresh produce at the Christiansburg Farmers Market.

Funded by a $2,300 grant from the Community Foundation, VIPA is a pilot program to increase food access and affordability for low-income citizens in Montgomery County, by providing vouchers and nutrition education.

Read the full article.

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Virginia News

Increase in Overdoses

From the Northern Shenandoah Valley Substance Abuse Coalition 

Recently, agents with the Northwest Virginia Regional Drug Task Force have responded to eight overdoses in Winchester and Frederick County.  Lab results will determine the narcotics used in the overdoses, but investigators believe six of the cases involved heroin and the other three involved synthetic drugs.  The victims of the overdoses are expected to survive. 
 
This year 21 people in the Northern Shenandoah Valley have lost their lives to a heroin overdose.  Another 75 individuals have reportedly overdosed and survived.  Prior to the eight overdoses over the past three days, our region had not had a reported overdose in more than a week.  Last year 30 people died as a result of a heroin overdose and 55 non-fatal overdoses were reported. 
 
The Task Force has been able to determine that the heroin used in most of these cases came out of Baltimore.  Agents are continuing to investigate the incidents.
 
The Northern Shenandoah Valley Substance Abuse Coalition is alerting the public about the dangers of heroin and its potential for overdose.  We are asking the public to pay attention to the behaviors of individuals around them, and if they notice any of the following general signs of substance use, to seek help. 

Read the full press release.

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School Nursing

By Josh Mandell - Charlottesville Tomorrow

Until recently, children who came to Albemarle County elementary schools with a fever or who sprained an ankle at afternoon recess couldn’t see a nurse right away. Before the 2015-16 school year, all but one of Albemarle’s elementary schools kept a nurse on duty for just six hours of each school day. These hours did not include bus arrival and departure times. Only the nurse at Hollymead Elementary, who also serves as the division’s school nurse coordinator, worked extra hours.

Albemarle County Public Schools is now working to have nurses stationed at elementary schools for the entire day to treat students in those situations— and in life-threatening emergencies.All of Albemarle’s middle schools and high schools have full-time nurses.

Employing a nurse full-time at a much smaller elementary school represents a greater per-student cost. But leaders of the division say this saves valuable time for principals, teachers and staff, who have to deal with student health issues when no nurse is present.

Read the full article.

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Merger Discussion

By David McGee - Bristol Herald Courier

A majority of speakers Monday favored the proposed merger of two area health systems during a listening session at Lebanon High School. Seventy-five percent of speakers expressed support for a cooperative operating agreement between Mountain States Health Alliance and Wellmont Health System. Their comments came during the first of two listening sessions hosted by the Southwest Virginia Health Authority, which must determine if it will recommend the agreement.

The two systems have committed to keeping all existing rural hospitals open for at least five years. Mountain States CEO Alan Levine said Monday they chose five years because of “not knowing what might happen in health care after five years.” The Lebanon hospital historically loses money and is subsidized by revenue from other MSHA facilities, Levine said.

Read the full article.

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National News

Post Election Analysis 

Please join the National Rural Health Association on Wednesday, November 16th at 12 pm ET, for a webinar providing an analysis of the election and what it means for rural America.

Registration link: attendee.gotowebinar.com/register/6113349899528652291

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MACRA Final Rule

By Diane Calmus - National Rural Health Association

CMS today released the final rule on the implementation of the Medicare Access and CHIP reauthorization Act of 2015 (MACRA). CMS also released a Quality Payment Program website designed to help providers understand the regulation. 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).

The regulation just released will impact providers starting January 1, 2017, though CMS has provided providers the ability to test out the program before being subject to payment adjustment (adjustments for 2017 data would apply to 2019 payments). However, to avoid payment reductions providers need to report at least some data to the Merit-based Incentive Payment System or participate in an advanced alternative payment system.

NRHA has commented at each stage of the development of the regulations for MACRA to encourage CMS to consider the special needs of rural providers and to express concern with the potential negative impact on rural providers. We will be reviewing the regulation and will provide additional information in the coming days and weeks.

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Non-Expansion Pain



It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.

The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.

Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.

Read the full article.

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Rural Publications

Telemedicine Penetration and Consultation among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota
Trauma is the leading cause of death for Americans ages 1 to 44, and rural trauma patients have disproportionately high injury mortality rates. To help address the needs of rural trauma patients, emergency department (ED)-based telemedicine services are increasingly being used. The objective of this study was to describe the penetration of ED-based telemedicine in North Dakota critical access hospitals (CAHs), and to describe hospital and geographical factors that contribute to increased telemedicine utilization in rural ED trauma. This cohort study used the North Dakota Trauma Registry and Avera eEmergency subscription records and call log from 2008-2014. All North Dakota trauma patients were matched to the Avera eEmergency call log to evaluate whether telemedicine was consulted in their care. Hospital-level factors were obtained from the 2012 American Hospital Association survey. 

Using area health education centers to promote interest in rural practice
This project report examines the role of Area Health Education Centers in promoting interest in rural practice. Findings support the contributions of academic-community partnerships with AHEC to supporting rural practice upon graduation.

Supply and Distribution of the Behavioral Health Workforce in Rural America
There are large differences in the supply of behavioral health providers available to treat rural residents when compared to their urban counterparts. Nationally, the provider to population ratio of psychiatrists and psychologists in Non-Metro counties is less than half the ratio than in Metropolitan counties. Additionally the supply of social workers, psychiatric nurse practitioners and counselors in rural counties is much lower than urban counties. Non-Core counties have the lowest provider to population ratios for all of the five provider types studied. Seventeen percent of all non-core counties lack any of the behavioral health providers studied. 

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster
This study explores healthcare providers' perspectives about community health, healthcare access and wellbeing in the context of a disaster recovery event in South Carolina. Following a disaster, agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities, and healthcare providers can offer a well-rounded assessment of community needs.

Application of a Telecolposcopy Program in Rural Settings 
Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit.

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Mark Your Calendar

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

October 26: Opioid Epidemic in Our Emergency Departments - webinar
October 27: RHC Update Seminar - Compliance and Billing - Nashville, TN
November 3: Aging in Appalachia Conference - Marion
November 3: Treatment Referral in an Opioid Crisis - webinar
November 9: Health System-wide Peer Program Opioid Crisis Best Practice - webinar
November 10: Virginia Oral Health Summit​ - Richmond
November 18: Virginia Telehealth Summit - Charlottesville
November 18: 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

Ups and Downs: Trends in Rural Children’s Access to Care
Jan Probst, PhD, Professor, University of South Carolina, and Director of the South Carolina Rural Health Research Center presented findings from a study based on the National Surveys of Children’s Health. For many groups of rural children, access to care rose between 2003 and 2007, but dipped slightly in 2011-2012.

Keys to Writing a Successful Rural Health Network Development Grant
Webinar slides and recording from the National Organization of State Offices of Rural Health

Profile of Virginia's Uninsured
Using data from an analytical approach it has developed. The report commissioned by the Virginia Health Care Foundation, utilizes the most recent in-depth data available (2014/2015). Highlights from the newly released report include:

  • Over 12.5% of Virginians under age 65 are without medical insurance - equaling 874,000 uninsured Virginians, down from 995,000 in 2015.
  • The vast majority (75.8%) of non-elderly uninsured are part of working families.
  • By far, the greatest percentage of uninsured Virginians are U.S. citizens (77%). 



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Funding Opportunities

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

Department of Agriculture
The Farm to School Grant Program supports efforts that improve access to local foods in schools. Grants are made for planning, implementation, support services, and training. The application deadline is December 8, 2016.

EQT Foundation
The EQT Foundation supports nonprofit organizations in the communities that the company serves in eastern Kentucky, western Pennsylvania, and the states of Ohio, Virginia, and West Virginia. The Foundation gives priority to programs that address the following areas: The Education category focuses on providing economically disadvantaged students with greater access to programs that enhance proficiency in core academic skills. The Community and Economic Development category promotes the development of livable communities that can attract residential and commercial growth and sustain a healthy local economy. The Environment category supports the preservation of local natural resources as well as activities to minimize adverse impacts on the environment. The Arts and Culture category encourages initiatives that are designed to give economically disadvantaged youth more exposure to artistic programming, or that promote expanded awareness of the diverse culture and heritage of Appalachia.
The application deadlines are February 1, May 1, August 1, and November 1, annually.

Department of Health and Human Services
The Nursing Workforce Diversity program seeks to increase nursing education opportunities for individuals from disadvantaged backgrounds, including ethnic and racial minorities who are underrepresented among registered nurses.
The application deadline is November 14, 2016.

Federal Emergency Management Agency
The Assistance to Firefighters Grant program provides support to help firefighters and other first responders obtain critically needed equipment, protective gear, emergency vehicles, training, and other resources needed to protect the public and emergency personnel from fire and related hazards.
The application deadline is November 18, 2016. 

Health Resources and Services Administration
The Rural Health Network Development Program supports mature, integrated rural healthcare networks that have combined the functions of the entities participating in the network in order to address the healthcare needs of the targeted rural community.
The application deadline is November 28, 2016.

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