Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  May 11, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


May newsletter





Hospitals Work!

Research shows that community health services provide more than medical care. Rural health providers have a reciprocal effect on the community’s jobs, commerce, and overall economy.

How do you demonstrate that effect?  Through Rural Health Works!

VRHA is partnering with the National Center for Rural Health Works to provide a FREE webinar series on the economic impact of healthcare in rural communities. The last webinar will be:

  • May 28: Impact of a Small Rural Hospital

Visit the VRHA webinar page for details and registration.

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Telehealth Webinars

VRHA has partnered with WeCounsel to offer you a 3-part webinar series on telehealth.  This series will provide a high level understanding of what it takes to effectively implement a successful telehealth program.

  • May 19th:  will focus on the regulatory environment for Telehealth in the state of Virginia as well as at the federal level.  We will answer questions regarding how telehealth is regulated in Virginia, crossing state lines and the implications of HIPAA on telehealth providers. 
  • Date TBA: will highlight reimbursement policies for the state of Virginia in regards to telehealth. Getting paid is critical to any successful telehealth program.  Join us as we discuss the reimbursement landscape for Medicare/Medicaid and private payers in regards to telehealth, and how telehealth can be a successful revenue stream for your practice. 
  • Date TBA: will outline effective use cases and how to develop an effective business model for a Telehealth initiative. This webinar will cover exactly how to plan, develop and implement a successful telehealth initiative. 

The webinars are free to all Virginia rural health stakeholders, regardless of VRHA membership status - so feel free to pass this information along!

Visit the VRHA webinar page for details and registration.

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Members in the News


One Valley hospital is breaking ground on a new addition that will expand its services and decrease your waiting times to see a doctor. [VRHA member] Shenandoah Memorial Hospital in Woodstock broke ground on an emergency room that it hopes will fill the need for care.

The current emergency room has seen a 17 percent growth in patient volume over the last three years. The project is expected to be completed in summer 2016.

Watch the video.

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Virginia News

Missing the Point

By Massey Whorley - Commonwealth Institute

If followed, the findings of a recent Thomas Jefferson Institute for Public Policy report would do nothing for thousands of Virginians who today can’t afford regular health care.  Rather than closing the coverage gap to help 195,000 people get health coverage, the report concludes the best option is to give more tax dollars to smaller rural hospitals. In making this backwards argument, the report gives short shrift to the reason Virginia needs to close the coverage gap – helping hard-working people afford to see the doctor when they need to. Instead, it focuses on hospitals’ financial bottom lines.

It’s about helping 195,000 people see the doctor when they need to. It’s about helping them get regular check-ups and catching medical problems early to avoid costly complications later. It is about helping people across the state – from Norton to Norfolk – rest assured that if they get sick or hurt the doctor’s visit won’t bankrupt them.

Read the full article.

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Purchase Complete

By Nick Shepherd - TimesNews

Lee County Hospital Authority is aiming to open up at least a portion of the former Lee Regional Medical Center by mid-November after the acquisition of the building was completed.

The purchase of the hospital was approved by commissioners when they signed a contract agreeing to pay Wellmont Health Systems $1.6 million for the building. Wellmont closed the Pennington Gap hospital in 2013 after 70 years in operation, citing reimbursement cuts, low community use and lack of consistent physician coverage.

Now that they own the building, the Authority will need to bring in millions of dollars to renovate and operate the hospital.

Read the full article.

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Close to Home

By Kimberly Becher, M.D. - AAFP

Medical schools and residency programs tend to be in larger cities, in part to provide inpatient training and to ensure there is enough volume to train physicians appropriately. Fortunately, there are programs that focus on rural outpatient education and place students and residents in rural settings for rotations or for continuity throughout their training, but even these learning opportunities are still within proximity of an academic center. 

Thus, many of us never practice in isolated rural settings during our training. This is my first year out of residency and my first in a truly rural setting -- Appalachia in Clay County, W.Va. I expected patients to have transportation challenges, I anticipated there would be socioeconomic barriers to care, and -- as is the case in many locations -- I was sure I would see fluctuations in the volume of patients coming in for treatment because of adverse weather. 

Read the full article.

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National News

Hospital Payment Fairness 

By Erin Mann - National Rural Health Association

The National Rural Health Association is pleased Sen. Claire McCaskill (D-MO) is reintroducing the Hospital Payment Fairness Act with Sen. Richard Burr (R-NC) as a push to repeal the piece of the Affordable Care Act that has resulted in a wage increase for all Massachusetts hospital physicians and staff at the detriment of rural hospitals across the nation.

The provision required Medicare reimbursements to all providers in a state be higher than the wage at the state’s rural hospitals. Massachusetts has only one “rural” hospital to set that floor, resulting in all wages in the state rising at the expense of other states. The Affordable Care Act establishes a pool of money for which hospital wages can be reimbursed via Medicare. Because of this, an increase for one state decreases the funds available for other states.

NRHA supported this legislation when it was previously introduced and will support it again.

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Opposing CAH Cuts

By Erin Mann - National Rural Health Association

Senators and testifying witnesses expressed concerned over the proposed cuts to critical access hospitals (CAHs) in the president’s budget, during the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on rural health programs in the Health and Human Services fiscal year 2016 budget.

The budget calls for reducing reimbursement for all CAHs from 101 percent of “reasonable costs” to 100 percent of reasonable costs and eliminating the critical access designation for hospitals closer than 10 miles to the nearest hospital, regardless of community need, the type of facility less than 10 miles away, or the reason a governor designated the hospital as a necessary provider.

Read the full article.

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Post-ACA World

By Julie Henry - Healthcare Dive

Since the Affordable Care Act (ACA) was signed into law in 2010, 48 rural hospitals have closed and nearly 300 more are on the brink of closure, according to the National Rural Health Association (NRHA). Hospitals report that one of the biggest reasons rural hospitals are being forced to close post-ACA is cuts to both Medicare and Medicaid reimbursement, both of which are major payment sources for rural hospitals.

Critical access hospitals (CAHs) may soon take a hit, as well. Medicare reimburses CAHs at 101% of their reasonable costs for providing services to beneficiaries, rather than at rates set by Medicare's prospective payment system (PPS) or Medicare's fee schedules. The Office of the Inspector General has proposed a new rule that may lower reimbursement for swing bed services to the same rates paid to skilled nursing facilities (SNFs). Medicare pays for SNF services at predetermined daily rates (under the SNF PPS). The daily rates vary on the basis of the resource utilization group to which a beneficiary is assigned.

Read the full article.

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Rural Publications

Knowledge and perceptions of tobacco-related media in rural Appalachia
Selling tobacco or not selling is about perception. Messages from the mainstream media may not be a good fit with populations outside of the mainstream. What did the authors learn about Appalachian populations that could be helpful to those desiring to decrease tobacco use?

A Rural Taxonomy of Population and Health-Resource Characteristics
This policy brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics; and discusses how this classification tool can be utilized by policy makers and rural communities. Using the most current data from multiple sources, we applied the cluster analysis to classify 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. In descending order, the most significant dimension in our classification was facility resources, followed by provider resources, economic resources, and age distribution. Each type of rural places was distinct from other types of places based on one or two defining dimensions. 

Characteristics of Rural Communities with a Sole, Independently Owned Pharmacy
In this policy brief, we characterize the population of rural communities with a single independently owned pharmacy. We find that over 2.7 million people, over 25 percent of whom live below the federal poverty level, reside in 663 rural communities with a sole independently owned pharmacy in 2014. For about 70 percent of these rural communities, the next closest pharmacy is more than ten miles away. 

Feasibility of a rural palliative supportive service
The health of rural residents can be met through innovative solutions. The feasibility study presented here discusses a palliative care approach in rural areas and found that it can enhance the quality of life of rural residents who need this assistance.

Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
Analysis of nationwide county-level Health Insurance Marketplace plan and premium data for 2014 and 2015 provides evidence that many low-density rating areas are gaining firms and that average premium growth is low in many rural areas. However, premium growth is somewhat higher in low-density rating areas, and a small minority of rural states have experienced large average premium increases. Thus there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes. 

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Mark Your Calendar

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

May 19: Regulatory Environment for Telehealth - webinar
May 28: Impact of a Small Rural Hospital - webinar
May 27: What Suicide Interventions Outside of Health Care Settings Reduce Risk? - webinar
June 4: Transformation in the Health Care Industry - Richmond
June 24: What Research Infrastructure Do We Need to Reduce Suicidal Behavior - webinar

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Intra Rural and Urban Primary Care Physician Findings: AAMC 2009 Physician Survey of Primary Care Chartbook
This publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, Federal Office of Rural Health Policy by Gary Hart Associated under HRSA contract. The report utilizes primary care physician (PCP) survey data, collected by the Association of American Medical Colleges (AAMC) in 2009/2010 shortly before the Affordable Care Act was made law to preserve a baseline from which to compare future post Affordable Care Act implementation surveys. 

CLAS Academy Training Catalog
The 2015 CLAS Academy Training Catalog is critical for reducing what are well-established health disparities in the US among racial, ethnic, and other minorities. The Catalog is designed to support the planning and implementation of critical components that are necessary for effective and responsive service delivery in behavioral health and developmental services.

Are You Writing for the Wrong Donors?
Although grant programs may be somewhat similar from agency to agency or federal to foundation, glaring differences stand out at all stages of the process. This blog identifies how to best target your efforts.

American Lung Association Releases 2015 State of the Air Report
What’s the state of America’s air? Overall, air quality has improved, but too many people still live where air pollution puts their health at risk. 

Food Access Mapping Tool
Interactive food mapping access tool for Virginia will provide Policy Map research and data

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Funding Opportunities

Appalachian Community Fund: LGBTQ Initiative
The Appalachian Community Fund encourages grassroots social change in Central Appalachia (eastern Tennessee, eastern Kentucky, southwest Virginia, and all of West Virginia). The Fund’s LGBTQ Initiative is designed to support LGBTQ organizational building, strengthen lesbian and gay community institutional resources, and build capacity for LGBTQ organizing efforts. Organizations that work with LGBTQ youth as well as networking efforts to connect LGBTQ groups throughout Central Appalachia are also supported. Requests for grants ranging up to $2,000 may be submitted throughout the year. Visit the Fund’s website to download the application instructions for the LGBTQ Initiative.

Dental Trade Alliance Foundation
The Dental Trade Alliance Foundation is dedicated to supporting promising initiatives that achieve measurable impact and facilitate real change in oral health care. The Foundation is offering grants of up to $25,000 for innovative, sustainable, scalable projects designed to increase access to oral health care 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 who are elderly or medically compromised.) The application deadline is May 27, 2015.

PeopleForBikes Community Grant Program
The PeopleForBikes Community Grant Program offers funding for important and influential projects that leverage federal funding and build momentum for bicycling in communities across the United States. Grants of up to $10,000 are provided for bicycle infrastructure projects and targeted advocacy initiatives that make it easier and safer for people of all ages and abilities to ride. Eligible applicants include nonprofit organizations with a focus on bicycling, active transportation, or community development; city or county agencies or departments; and state or federal agencies working locally. Letters of interest for the fall 2015 grant cycle will be accepted from June 15 to July 31, 2015. 

Rural Child Poverty Telehealth Network Grant Program
Rural Child Poverty Telehealth Network Grant Program will award funding to telehealth networks that integrate social and human service organizations. Networks must demonstrate how integration of social and human service organizations can expand access to, coordinate, and improve the quality of healthcare services for children living in impoverished rural areas.
Deadline: June 22, 2015

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Virginia Rural Health Association
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Blacksburg, VA 24060

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