VRHA Weekly Update
In this Issue July 21, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


July Newsletter





Members in the News

By VRHA Member Deena Flinchum - News Messenger

Last month brought the determination by the Centers for Medicare and Medicaid Services (CMS) that certain Medicare preventive services will no longer be considered medically necessary if performed as a stand-alone service in Rural Health Clinics (RHC) or Federally Qualified Health Centers (FQHC). Bill Finerfrock, executive director of the National Association of Rural Health Clinics stated; 

"What makes this determination particularly offensive is that CMS will continue to pay for these preventive services as stand-alone services when provided in other settings."

Read the full article.

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More Members in the News

By Stacey Hairston -Franklin News-Post

If a disaster were to strike, [VRHA member] Carilion Franklin Memorial Hospital (CFMH) has made sure it is able to still treat its patients. A Stabilization Treat in Place (STIP) tent, set up in the hospital parking lot recently, was available for viewing by hospital staff.

"Every year at CFMH, we do an inventory of the emergency preparedness equipment available to us in the event of an emergency," said hospital Administrator Bill Jacobsen. "This tent can be used as an emergency unit during disasters or if the hospital was to become overwhelmed due to a community disaster." 

Read the full article.

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Even More Members in the News

By Josette Keelor - NV Daily

Work on an $18 million facility on the campus of [VRHA member] Shenandoah Memorial Hospital in Woodstock should begin next year and will include a new emergency room, onsite urgent care center and office building for physicians who currently have offices in the community, Floyd Heater, hospital president, said Monday.

"It's just part of a very exciting chapter for SMH," Heater said. "It really kind of represents one of the final stages of a master facility plan that we set out to do about 10 years ago."

Read the full article.

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Virginia News

Opinions on Expansion

Virginia's battle over Medicaid expansion has generated diverse opinions.  Here's a sampling of what has been in the editorial columns lately:

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RAM Demand

By Allie Robinson Gibson - Bristol Herald Courier  

Volunteer physicians and nurses may see more patients at this year’s Wise County Remote Area Medical Clinic because of layoffs in the coal industry.
RAM organizers at The Health Wagon, a free health care clinic that leads the RAM clinic in Wise, are gearing up for this year’s event, to be held July 18 to 20, said Paula Meade, clinical director for The Health Wagon.

She said that because state legislators didn’t expand Medicaid, people without medical coverage — many of whom are past RAM patients — will be back this year. And recent layoffs in the coal mines — 300 people have been laid off by CONSOL and Alpha Natural Resources in the past few months — are expected to bring even more patients, Meade said.

Read the full article.

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Close to Home

By Paul Hitchcock - WMKY

Kentucky Auditor Adam Edelen will host a series of public hearings across the Commonwealth this summer to talk about the fiscal health of rural hospitals. The 10 hearings kick off a study by the Auditor’s office that seeks to understand the challenges facing small, community hospitals that provide health care to 45 percent of Kentuckians and are key economic drivers in those communities.

“Rural hospitals are teetering on the edge of survival in many Kentucky communities,” Auditor Edelen said. “This is an effort to understand the degree to which our hospitals are in crisis and what might be done to save them.”

Read the full article.

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National News

Gap Worse in Rural Areas

By Savannah Wooten - Daily Yonder

Rural residents who don’t have medical insurance are disproportionately affected by state decisions not to expand Medicaid under the Affordable Care Act. About two-thirds of uninsured rural residents currently reside in states that have not implemented Medicaid expansion. Nationally, 52% of uninsured Americans live in states that didn’t expand Medicaid.

That means rural residents are more likely than average to live in a state that didn’t expand Medicaid. Because uninsured rural residents are more likely to live in states that didn’t expand Medicaid coverage, they face special challenges, the study says. They are more likely to fall in the “coverage gap” – where they earn too much to qualify for Medicaid but too little to qualify for tax credits to purchase private insurance.

The study shows 15% of nonelderly rural uninsured fall in the coverage gap, while only 9% of their urban counterparts do.

Read the full article.


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​Belhaven, NC mayor Adam O' Neal continues on his long walk to Washington D.C. in hopes of saving Vidant Pungo Hospital.  The hospital closed July 1st, leaving residents of Hyde and eastern Beaufort counties without a hospital or emergency room.

He says his decision to make the walk is an illustration of how serious this problem is."The purpose of the walk would be to talk about what happened to us,” said Mayor Adam O’Neal who says this walk isn't just about Vidant Pungo Hospital, but about the closure of rural hospitals across the United States.

"We have hospitals closing up at an alarming rate. More rural hospitals have been closed in the last year than in the previous 15 years. That is a trend that's got to be stopped," said O’Neal.

Read the full article and join the action!  A series of events will be held as Mayor O'Neal walks through Virginia:

  • On Monday, July 21, the mayor will eat lunch in Petersburg at noon at Croaker's Spot with supporters and members of the press. 
  • Tuesday, July 22, 2pm the mayor will hold an event at the Bell Tower on Capitol Grounds. Downtown Richmond, VA.  VRHA member Rhonda Seltz will be speaking at the event.

  • Friday, July 25, there will be an event held in Fredericksburg.  Time and location are TBA.

Please put the events on your calendar and promote them to your organizations, members, and local media markets.  We would love to have as large a turn out and coverage as possible.
If you have any questions, please contact Healthcare for All Virginians.  You can also learn more about the mayor and follow his journey at www.saveourhospital.org.

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Rural Hospitals Losing

By  Columbus Dispatch

For years, stress fractures induced by the U.S. health-care system’s unsustainably high costs have crept throughout Ohio. But more than anywhere else in the state, those strains have been laid bare in rural counties, where hospitals typically rank among the top employers but these days, often teeter on the brink of unprofitability.

At many of the state’s rural hospitals, black ink on balance sheets has given way to red. A snapshot in January by iVantage Health Analytics found that hospitals in Ohio’s metro counties were running slightly in the black — revenue exceeded expenses by 0.8 percent on average — while those in non-metro counties had narrow losses of 0.92 percent.

“We live on a thinner margin to begin with because we’re not bolstered by a larger population of commercial payers,” said Scott Cantley, CEO of Memorial Health System in Marietta, which has employed half a dozen consultants to help it become leaner.

Read the full article.

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Rural Publications

Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women
Rural low income women often have high rates of obesity. They also face challenges regarding education Can a goal-setting intervention be effective in moving toward behavioral change? How do individual, social, and environmental factors impact goal setting?

Rural emergency medical technician pre-hospital electrocardiogram transmission
In cardiac emergencies, time is money - and heart muscle lost. Delays in intervention impact lives, health costs, economics, morbidity, and mortality. In urban settings advanced technician EKG transmission often occurs with direct transport to intervention facilities. In rural areas, stacked with basic emergency medical technicians, cardiac care with EKGs could and should be similarly advanced.

Heart attack symptoms and decision-making: the case of older rural women
Few specific health conditions have been thoroughly studied in the rural context. A case in point is the experience of rural women and 'heart attack' symptoms. The qualitative research presented here attempts to address a knowledge gap for both clinicians and community members.

Understanding the distinct experience of rural interprofessional collaboration in developing palliative care programs
New knowledge about rural palliative care team-work adds value when devising rural palliative care services.

Trends in Hospital Network Participation and System Affiliation, 2007-2012
Network participation and system affiliation represent two viable ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value model of care delivery. This policy brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012. Network participation increased in larger hospitals, non-government not-for-profit hospitals, and metropolitan hospitals. System affiliation generally increased in hospitals of all sizes and types. However, there are notably higher percentages of system affiliation among midsized and large hospitals, investor-owned hospitals, and metropolitan hospitals compared to their counterparts. 

Diabetic education in rural areas
Diabetes is a major health problem with serious impacts in rural America. This useful review of the literature examines what works specifically for rural adult populations.

Preventing rural workforce by design
Across the world, countries struggle to organize education and funding systems for equitable access to health services and clinicians. Could failure to achieve this in the USA be predicted from analysis of recent health and education policy? This commentary suggests this is so - but will we learn the lessons?

Support for Rural Recruitment and Practice among U.S. Nurse Practitioner Education Programs
Describes nurse practitioner (NP) education programs across the United States to identify those actively promoting NP practice in rural areas; describes their use of education methods that may promote rural practice; and identifies barriers to recruiting rural students and providing rural NP clinical training. Programs reported that relocating or commuting to campus-based programs, limited rural training opportunities, and affordability were barriers for rural students. 

Update: Independently Owned Pharmacy Closures in Rural America, 2003-2013
Pharmacists provide a range of health services and their loss can have serious implications for the provision of health care, especially in rural areas. Previous policy briefs from the RUPRI Center for Rural Health Policy Analysis have documented the decline in the number of independently owned pharmacies in rural area, especially between 2003 and 2010. This update shows that the number of independently owned rural pharmacies has, with some minor fluctuations, continued to slowly decline. In addition, the number of rural retail pharmacies (including independent, chain, or franchise) that were the only pharmacy in the community has remained relatively stable since 2010. 

Nurses experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting
Rural health issues often focus on diseases and conditions rather than life transitions. In this qualitative study, the perceptions of rural community health nurses who provide palliative care in residential settings provide findings useful in understanding this major life transition in this specific geographic context.

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Mark Your Calendar

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

July 23: Driving Referrals, Improving Health with HIE - webinar
July 30: Valuations: What Rural Providers Need to Know - webinar
September 30-October 1: Rural Health Clinic Conference - Kansas City, MO
October 1-3: Critical Access Hospital Conference - Kansas City, MO
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton​

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2014 Virginia Atlas of Community Health 
The 2014 Virginia Atlas of Community Health has been released.  Updates to the Atlas include the following: 

2014 Data Updates

  • All data profiles have been updated with the most current data available.
  • The Maternal and Infant Health Profile has been updated and includes three new indicators.
  • The Prevention Quality Indicator Hospital Discharge Profile has been revised using the most current methodology from Agency for Healthcare Quality and Research (AHRQ) . 
  • The Health Coverage Profile has been updated, and includes new estimates for adults age 19-64 and children 0-18 with incomes at 138-400% Federal Poverty Level. The profile also includes State Fiscal Year 2013 Medicaid Enrollment data.
  • Communicable Disease Profile (2013) has been added.

2014 Mapping Updates
A number of enhancements have been added to the portal to produce more illustrative and customized maps that can be downloaded for use in Word, PDF and PowerPoint documents: 

  • The Layers Tab has been updated with more user-friendly toggle buttons.
  • The Tools Tab contains a new Highlighting and Labeling tool. 
  • Users can now export the map and legend separately. 
  • Users can now adjust the map size.
  • Users can now customize the legend placement

Webinar Wednesdays  
Every Wednesday from July 30-August 27, the Atlas team will conduct a series of introductory webinars from 11:00AM to 12:00PM. The purpose of Webinar Wednesdays is to provide users with an overview of the 2014 Virginia Atlas of Community Health.

MLN Connects Provider e-News


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Funding Opportunities

AMA Foundation Healthy Living Grant (Formerly Fund for Better Health)
Application deadline: Sep 12, 2014
Provides healthy lifestyles seed grants for grassroots public health programs. This year's grants are supporting projects in the area of Prescription Drug Safety.

Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multilevel Approach (UH2/UH3)
Letter of Intent (Required): Nov 9, 2014
Application deadline: Dec 9, 2014
Awards grants to multidisciplinary teams to test an intervention related to children's oral health or evaluate outcomes of an existing program or policy intended to reduce oral health disparities and inequalities, with the goal of improving oral health for low-income rural or urban populations.

Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards
The Rosalinde Gilbert Innovations in Alzheimer's Disease Caregiving Legacy Awards, administered by the Family Caregiver Alliance, are intended to promote innovation in the field of Alzheimer’s caregiving by recognizing efforts which lead the way in addressing the needs of Alzheimer’s caregivers. Three awards of $20,000 each will be presented to nonprofit organizations, government agencies, or universities in the following categories: The Creative Expression award encourages programs that use imaginative approaches in supporting family/informal caregivers or persons with Alzheimer's disease or related dementias. The Diverse/Multicultural Communities award recognizes outreach programs to family/informal caregivers in ethnic, rural, low-income, LGBT, and other diverse communities. The Policy and Advocacy award promotes programs that advocate for systems change for the benefit of family/informal caregivers or care recipients with Alzheimer's disease or related dementias. The application deadline is August 22, 2014. ​

Department of Health and Human Services
The Service Area Competition provides support to improve the health of underserved communities and vulnerable populations by ensuring access to comprehensive, culturally competent, quality primary healthcare services. The application deadline is August 13, 2014. ​

Robert Wood Johnson Foundation
Deadline: 09/27/14
Funding that honors outstanding community efforts and partnerships that are helping people live healthier lives. Up to ten communities across the United States will be awarded and have their accomplishments celebrated and shared broadly with the goal of raising awareness and inspiring locally driven change. 


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