Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  April 18, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


April Newsletter





Members in the News

From VRHA member Virginia Hospital & Healthcare Association

A Task Force established to examine ways to reduce opioid abuse, particularly related to emergency room prescribing practices, has developed a set of recommendations to help guide hospital emergency departments in an era when prescription drug misuse has become more prevalent. The Task Force was created by action of the Virginia Hospital & Healthcare Association’s (VHHA) Board of Directors in January 2016. Work over the next several months by representatives from VHHA-member organizations and the Virginia College of Emergency Physicians produced 14 recommendations for setting general standards on opioid prescribing in Virginia hospitals’ emergency departments, which in 2014 had nearly 3.6 million patient visits.

The recommendations address specific instances in which emergency department (ED) personnel should exercise caution in prescribing opioids for treating chronic pain. They advise prescribers to dispense medications for the shortest time possible. They encourage greater communication between ED prescribers and patients’ primary care physician. They discourage the practice of providing replacement prescriptions, and advise caution when dispensing medication to patients without photo identification. They encourage providers to consult the Prescription Monitoring Database before making opioid prescriptions. They discourage the prescription of long-acting and controlled release opioids. And they encourage hospitals and ED providers to use clinical judgment regarding prescription decisions and care coordination to help patients appropriately and safely manage pain.

Read the full press release and download the related infographic and guidelines.

VHHA is hosting a free webinar on Wednesday, April 20, 2016 from 12:30 PM - 2:00 PM  highlighting how a Northern Shenandoah Valley community coalition developed strategies to effectively respond to the challenge of heroin and opiate abuse in a rural Virginia community. Those interested can register for “The Addiction Crisis: A Community’s Response” webinar through this link.

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More Members in the News

By Matt Brown - Cavalier Daily

The Batten School hosted an event Wednesday afternoon discussing health disparities and the implications of class, race and location, among additional social determinants, in regard to health issues and access to care in Virginia.

Among the speakers was [VRHA member] Michael Royster, vice president of the Institute for Public Health Innovation, who said Virginia experienced similar health disparities to the rest of the United States.

Read the full article.

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Virginia News

Medicaid & Mergers

By Scott A. Surovell - Richmond Times Dispatch

With the end of the 2016 General Assembly session, Virginians are receiving updates from their legislators about our accomplishments. What Virginians are not hearing about is our failure to expand Medicaid for many of the commonwealth’s 400,000 most vulnerable patients — or what we plan to do to prevent the impending mergers of four of the nation’s largest health insurers from driving up premiums for all Virginians and the cost of doing business in Virginia. 

But make no mistake, both of these issues should have everyone concerned.

The failure to expand Medicaid raises serious questions about what is happening in our health care system. Thanks to unfounded resistance among conservative legislators to billions of dollars of federal monies, 30,000 new Virginia jobs and $180 million per biennium of immediate savings to Virginia taxpayers, and the willingness of hospitals to pay a fee, hundreds of thousands of Virginians will continue to fall into a significant coverage gap.

With the multibillion-dollar mergers of Aetna-Humana and Anthem-Cigna on the horizon, it is not surprising that a broad range of Virginia consumer groups wrote to Virginia’s Insurance Commissioner raising the alarm on the potential risks of these mergers. Past mergers have severely limited innovation among insurers, such as shopping, mobile health applications and price transparency resources.

Read the full editorial.

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Bank for the Underserved

By Joe Mahoney - Richmond Times Dispatch

Community Capital Bank of Virginia, a wholly-owned subsidiary of Virginia Community Capital Inc., is not a typical retail bank.  Community Capital Bank is one of about 10 banks in the country owned by a nonprofit, Henderson said.

It recently became the first regulated bank in the United States to become a benefit corporation, or B Corp, a type of business structure that emphasizes social causes and the environment in addition to making a profit. The conversion to benefit status underscores Virginia Community Capital’s mission to provide capital to low- and moderate-income people and in under-served markets.

Read the full article.

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Oral Health Integration Toolkit

From the Virginia Oral Health Coalition

The Virginia Oral Health Coalition is pleased to share a new resource for health providers who are interested in oral health integration: the Integration Toolkit.

The Integration Toolkit is an online resource that walks you through key steps of integration, from identifying your patients' major health care needs to analyzing financial models, and more. The toolkit includes:

  • Sample oral health integration models,
  • Prompt questions to consider with your team,
  • An integration checklist; and,
  • Many resources you can download and use today.

The Integration Toolkit was developed with grant funding from the Richmond Memorial Health Foundation, in partnership with The Daily Planet and Community Health Solutions. Thank you to these and other partners for providing resources and input.
For questions and feedback about the toolkit, or to submit additional resources, please contact me at 804.269.8721 or

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National News

Mortality Gap 

By Lenny Bernstein, Anne Hull and Kimberly Kindy - Washington Post

White women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s and 50s in a slow-motion crisis driven by decaying health in small-town America, according to an analysis of national health and mortality statistics by The Washington Post.

Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall. But for white women in what should be the prime of their lives, death rates have spiked upward. In one of the hardest-hit groups — rural white women in their late 40s — the death rate has risen by 30 percent.

In modern times, rising death rates are extremely rare and typically involve countries in upheaval, such as Russia immediately after the collapse of the Soviet Union. In affluent countries, people generally enjoy increasingly long lives, thanks to better cancer treatments; drugs that lower cholesterol and the risk of heart attacks; fewer fatal car accidents; and less violent crime.

But progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors.

Read the full article and related graphics.

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A Perfect Storm 

By Doug Bennett -

Nearly 700 rural hospitals across 42 states are now considered vulnerable to closure as a result of declining revenues, says a new report. Multiple cuts in Medicare reimbursement rates and unintended consequences of the Affordable Care Act (ACA) have helped to fuel the rate of closures since 2010, with 68 rural hospitals closed to date. If all of the 673 vulnerable hospitals ultimately do close, it would result in the loss of an estimated 99,000 healthcare jobs, another 137,000 local community jobs, 11.7 million patient encounters, and $277 billion in gross domestic product (GDP) over 10 years. 

One reason for the trend is the steady erosion of revenue to rural hospitals stemming from the annual 2 percent sequestration cuts to Medicare enacted in 2013. Medicare reimbursements typically account for 80 percent of rural hospital revenue. Additionally, 63 percent of rural hospitals identified as vulnerable to closure are in states that opted not to expand Medicaid in conjunction with the ACA. 

Read the full article.

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Has PPACA Failed Rural?

By Janelle Ali-Dinar, PhD - RAC Monitor

The Patient Protection and Affordable Care Act (PPACA), colloquially known as Obamacare, was signed into law by President Obama on March 23, 2010, and along with it the federal government has touted a string of successes for access to healthcare insurance and healthcare services from 2010-2020. Perhaps the greatest success outcome to date is that 17 million more consumers gained access to health insurance since the core of the PPACA took effect in 2013 (according to the RAND group study). 

Not everyone, however, has benefitted, as some 600,000 people who had individual coverage before passage of the PPACA ended up uninsured. In fact, the PPACA has left rural and underserved communities, healthcare systems, and vulnerable populations more financially fragile, especially minority families that still face racial and socioeconomic disparities even if they are insured. Additionally, while the PPACA increased insurance availability for the economically challenged by expanding Medicaid eligibility to more people based on their income level, it hasn’t panned out as initially thought and planned.

Read the full article.

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340B Implications 

By Kyle A. Vasquez - National Law Review

The Medicare Payment Advisory Commission (MedPAC) released its latest report to Congress that included 340B Implications for Medicare Part B Drugs along with a quick fact sheet regarding the report. Key highlights, as they relate to 340B entities, include:

  • MedPAC recommended that Congress reduce Medicare Part B payments to 340B hospitals by 10 percent of the average sales price (ASP) for separately payable 340B drugs. Currently, Part B pays 106 percent of ASP. The recommendations apply to all 340B hospitals (disproportionate share, critical access, sole community, children’s, freestanding cancer hospitals, and rural referral centers) but not grantees (Ryan White, FQHCs, etc.).
  • MedPAC also recommended that the 10 percent savings be allocated to the Medicare-funded uncompensated care pool for distribution to those hospitals that provide high amounts of uncompensated care.
  • Although MedPAC did not go into great detail in its report, it stated that 340B hospitals with high levels of uncompensated care (charity care and bad debt) would potentially experience an overall average increase in Medicare payments post-payment reduction while those facilities with low uncompensated care costs may see a slight overall decrease in Medicare reimbursement due to the drug reimbursement reduction.
Read the full article.

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Mark Your Calendar

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

April 18: Colorectal Cancer Roundtable - Roanoke
April 20: Virginia Statewide Opioid Webinar - webinar
April 25-26: National Reduce Tobacco Use Conference - Washington, DC
April 26: Virginia Colorectal Cancer Roundtable - Fairfax
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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Medicare Learning Network Provider e-News

Rural Services Integration Toolkit
This new toolkit offers strategies for rural communities seeking to integrate health and human services to increase care coordination, improve health outcomes, and reduce healthcare costs. 

The Growing Importance of Afterschool in Rural Communities
Provides an overview of afterschool and summer learning programming in rural America. Discusses health and wellness impacts of afterschool programs for rural children. Describes strengths of rural programs and identifies barriers to participation in rural communities.

Mapping Medicare Disparities
County-by-county interactive map providing information on geographic disparities in chronic disease among Medicare beneficiaries. Indicates disparities in health outcome, utilization, and spending among racial and ethnic minorities and geographic location.

Updated: Am I Rural? Tool
The Am I Rural? tool has been updated with a new interface and includes a map-based location verification. View the short video to learn how to use the tool's new features and then find out if your location is considered rural based on various rural definitions by using the tool. 

Understanding the Social Determinants of Health: A Self-Guided Learning Module for Rural Health Care Teams
Provides information and resources concerning the concept of social determinants of health, and encourages activities to help rural healthcare providers address these issues and improve the health of the communities they serve.

Pocket Guide for Treatment of Opioid Use Disorder – New from the Substance Abuse and Mental Health Services Administration, the downloaded guide “offers guidelines for physicians using medication-assisted treatment for patients with opioid use disorder” and includes information on the various types of approved medications, screening and assessment tools, and best-practices for patient care.

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Funding Opportunities

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

DTA Foundation Grant
Awards funding to projects designed to increase access to oral health care.
Application Deadline: May 25, 2016 

Semi-Annual Grant Program: Access to Care
Awards funding to projects that improve access to oral healthcare. Examples include screening programs, treatment programs, and dental clinics within a community healthcare facility.
Application Deadline: Jul 29, 2016 

Summer Food Service Program
Funding to provide free, nutritious meals and snacks to help children in low-income areas get the nutrition they need during the summer months.
Applications accepted on an ongoing basis 

Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility Grants
Due: May 31, 2016
$5.3 million of funding from two programs to support the Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility Grants (R2W Demonstration Grants). R2W Demonstration Grants are part of a series of activities to support FTA’s Rides to Wellness Program that seeks to address challenges for the transportation disadvantaged in accessing health and wellness services.
The Rides to Wellness Demonstration Grants Webinar will be held on Wednesday, April 20th 2016 from 3:30-4:30 p.m. EST, click here to register.

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