VRHA Weekly Update
In this Issue  February 2, 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 FREE webinar series on the economic impact of healthcare in rural communities.  Webinar 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

Visit the VRHA webinar page for details and registration.

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Members in the News

By Stephanie Porter-Nichols - SWVA Today

[VRHA member] Smyth County Community Hospital is leading the way among Virginia hospitals in a key aspect of patient care and safety.  James Tyler, SCCH’s CEO, came before the Marion Town Council to deliver what he described as good news. He reported on data recently released by the U.S. Centers for Medicare and Medicaid Services (CMS). The scores reflect patient safety and patient experience, including pain management, staff responsiveness, and communication from doctors and nurses.

A key CMS benchmark is the prevention of hospital-acquired conditions, including infections. Tyler said Medicare contends that hospital-acquired infections are 100 percent preventable. Examples of other hospital-acquired conditions include heart failure, strokes, blood clots and pneumonia.

Read the full article.

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More Members in the News

By Orlando Salinas - wdbj7

Ask any doctor if there's a shortage of physicians in rural areas and you'll get a fast ''yes.''  Sitting across from [VRHA member] Dr. Dixie Tooke-Rawlins, one gets the sense she's pretty simple, in a great way.

"Actually I began working at a nursing home when I was 16. I worked in the kitchen setting up trays and helped feed people."  Fast forward to 2015, and Dixie is now the new president and provost of the Edward Via College of Osteopathic Medicine or VCOM in Blacksburg.

Students, as part of their training, spend time in hard places like Appalachia and overseas where there aren't enough doctors. Tooke-Rawlins hopes her students will eventually practice medicine in rural America.

Read the full article.

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Virginia News

Legislative Watch

Recently introduced legislation which could impact health and healthcare in rural Virginia.

HB 2316: Southwest Virginia Health Authority; cooperative agreements. Allows the Southwest Virginia Health Authority (the Authority) to review and approve cooperative agreements among two or more hospitals for the sharing, allocation, consolidation by merger or other combination of assets, or referral of patients, personnel, instructional programs, support services, and facilities or medical, diagnostic, or laboratory facilities or procedures or other services traditionally offered by hospitals. The Authority shall approve a cooperative agreement if it determines that the parties to the cooperative agreement have demonstrated by a preponderance of the evidence that the benefits likely to result from the agreement outweigh the disadvantages likely to result from a reduction in competition from the agreement. 

SB 1380:  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 2330: Tobacco Indemnification and Community Revitalization Commission; financial viability and feasibility study prior to disbursement; Virginia Tobacco Region Revolving Fund. Requires the Tobacco Indemnification and Community Revitalization Commission (the Commission) to enter into a management agreement with a manager with respect to Commission loans, grants, and other distributions of money. The bill requires the manager to provide a written report on the financial viability and feasibility of any such distribution and prohibits the Commission from making the distribution until its viability and feasibility have received favorable recommendations from the manager. The bill eliminates future appointments of six nonlegislative citizen members, all tobacco producers, and requires 15 of the remaining 25 Commission members to have experience in particular fields. The bill requires the Commission to adopt policies governing the Tobacco Region Opportunity Fund; to require a dollor-for-dollar match from entities receiving grants; to make no distribution to a tobacco-dependent community solely based on the historical production of tobacco; to require each project to have an accountability matrix, provide a set of quantified outcome expectations and other figures, and demonstrate how it will address low employment levels or other indicators; to develop a strategic plan every two years; and to establish a public database of awards. The bill also establishes the Virginia Tobacco Region Revolving Fund (the Fund), the assets of which are to be used to make loans to local governments for the financing of any project. The bill empowers the Virginia Resources Authority (the Authority) to administer the Fund, pledge assets of the Fund as security for bonds issued to finance a project, sell or collect on loans made from the Fund, and, in accordance with a memorandum of agreement with the Commission, establish the rates and terms of loans. The bill directs the Commission, in conjunction with the Authority, to make an annual report to the General Assembly and the Governor on all loans made from the Fund.

HB 2358: Continuing education for prescribers; substance abuse, addiction, and related pain management and prescribing practices.

Truck Stop Medicine

By Susan Svrluga - Washington Post

The massive truck stops just off I-81 here offer diesel, hot coffee and “the best dang BBQ in Virginia.” There’s something else, too: a small-town doctor who performs medical exams and drug tests for long-haul drivers, an innovative effort to keep his beloved family practice afloat.

At a time when doctors are increasingly giving up private practice, Rob Marsh still operates his medical office in tiny Middlebrook, Va., about 15 miles from Raphine and 50 miles west of Charlottesville. He makes house calls and checks on his patients who are hospitalized — sometimes late at night. He knows which tough, leathery farmers will blanch as soon as they spot a needle.

For the past 2 1/2 years, Marsh, 58, also has reached out to another medically neglected population: the truck drivers who spend their days on the interstate, many never home long enough to find a primary-care physician.

At the TA Petro truck stop here, where Marsh opened his clinic in July 2012, drivers can get an oil change, work out, take a shower. And now they can get a U.S. Department of Transportation-mandated physical, a flu shot or treatment for a sore back.

Read the full article.

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Lee Hospital Purchase

By Tim Davis - WCBY.com

The Lee County Hospital Authority will buy the former Lee Regional Medical Center from Wellmont.  The group met Tuesday afternoon to talk about the purchase. Lee Regional Medical Center, in Pennington Gap, closed in 2013.

The State of Virginia granted a certificate of need for the hospital. Since then, the authority has been negotiating with Wellmont Health system to get ownership of the former hospital building.

Commissioner Tom Clarke tells News 5, "We're very pleased at the Wellmont board. They went out of their way. They met on December 30 telephonically to approve this agreement. The agreement allows for the building to be acquired to be owned by the Lee County Hospital Authority and allows us to operate hopefully in urgent care centers starting on April 1 and were still targeting the first of July to open the critical access hospital."

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Planning in Lenowisco

By Tammy Childress - TriCities.com

The Lenowisco Health District has been re-recognized by the National Association of County and City Health Officials (NACCHO) for its ability to plan for, respond to and recover from public health emergencies. The health district demonstrated these capabilities by meeting the comprehensive preparedness benchmarks required by Project Public Health Ready (PPHR), a unique partnership between NACCHO and the Centers for Disease Control and Prevention. Having first met these standards five years ago, the health district has once again demonstrated an ongoing commitment to preparedness and continuous quality improvement. The Lenowisco Health District, comprised of Lee, Scott and Wise counties and the City of Norton, re-joins a cohort of nearly 400 local health departments across the country that have been distinguished for excellence in preparedness through PPHR, either individually or as part of a region.

“We are proud to have been re-recognized by Project Public Health Ready for our high level of preparedness,” said Eleanor Cantrell, MD, district director of the Lenowisco Health District. “We will continue to improve our ability to respond quickly and effectively to any public health crisis in our area and to work collaboratively with other agencies and entities involved in response. However still one of the most important factors in determining whether we succeed in responding to an emergency will be the actions of our citizens in advance planning, cooperating with authorities and helping each other in a time of duress.”

Read the full article.

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National News

Raise Awareness

A message from Alan Morgan, CEO, National Rural Health Association:

I’m writing to ask you to help us to raise awareness of the rural hospital closure crisis.

You can help NRHA jumpstart our campaign to #SaveRural hospitals and patients by taking a moment to personalize this letter with your story to share with local and national news outlets.

Dear Editor,

Rural hospitals are closing nationally, hurting rural economies and leaving some of our nation’s most vulnerable populations without timely access to care.

Rural hospitals and health care workers are important to the communities they serve in [STATE]. They offer much-needed health care access, provide for a strong economy and are a social anchor for the region. Critical access hospitals on average create 107 jobs and provide about $5 million in annual wages, salaries and benefits within their local community.

We must stop proposed Medicare cuts to these hospitals that care for our families, friends and neighbors.

What happens when a hospital closes? Patients, taxpayers and the economy suffer. A recent iVantage Health Analytics study shows that rural hospitals are a good value, stating that “approximately $1.5 billion in annual cost differential (savings) occurred in 2012 because the average cost per rural beneficiary was 2.5 percent lower than the average cost per urban beneficiary.”

If Congress allows more rural hospitals on the brink of closure to shut their doors, 700,000 patients will lose direct access to health care, and more than 50 percent of rural Americans will have to drive 60 or more miles to receive specialty care.

Please join me in urging the president and Congress to protect hospitals like [NAME(S) OF HOSPITAL(S)] now.

Elected officials follow local and national newspapers, so the few minutes that it takes to send this letter today will be the foundation for in-person meetings during NRHA’s ongoing advocacy efforts, 


NOTE: if you would like to submit a letter, but feel you need assistance, please contact VRHA Executive Director Beth O'Connor (540-231-7923).

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Veterans to Paramedics 

By Lindsey Corey - National Rural Health Association

NRHA recently sent a letter to Sens. Mike Enzi (R-Wyo.) and Amy Klobuchar (D-Minn.) thanking them for introducing the Veterans to Paramedics Transition Act and their leadership in this critical area. The bill will streamline civilian paramedic training for veterans who gained emergency medical experience as a result of their military service, making it easier to secure jobs as paramedics.

Far too many rural communities have critical shortages of trained emergency personnel. At the same time, these communities are home to thousands of men and women who received emergency medical training while serving in the military. Yet, when they return, this military training and experience does not count toward training and certification as civilian paramedics.

This legislation goes far in accelerating and streamlining the transition to civilian employment for returning veterans, allowing them to continue to serve their communities in a new and needed capacity.

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Rural eCare

By Jake Iversen - KSFY

For many South Dakotans, choosing where to live also means choosing to live far away from the nearest emergency medical facility. However, thanks to improved technology, Avera Health is allowing doctors to reach patients all over the Midwest.

A phone rings breaking the silence of the morning. The sign that Dr. Garrett Taylor is going to have a busy day ahead of him. A nurse switches on the television and a full emergency room appears.  How is this tri-state travel possible? This is Avera e-Emergency. From an industrial park in Sioux Falls, Dr. Taylor has a cyber-link to 212 hospitals and clinics across the Midwest.

"We have two or three nurses working at any one time, an emergency physician that's here 24/7, 365 days and we are physically separated from the hospital, so this is the only thing that I am doing, the staff and myself this is our only job while we are here: to take care of our virtual patients." said Dr. Don Kosiak, an emergency physician at Avera eCare.

Read the full article.

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Rural Publications

We desperately need some help here - The experience of legal experts with sexual assault and evidence collection in rural communities'
There is little available literature on sexual assaults in rural areas. This qualitative study included interviews with legal experts to generate information about their experiences. The results will be useful not only for forensic nursing, but also for other rural-based community workers and agencies.

Rural-Urban Chartbook (The 2014 Update of the Rural-Urban Chartbook & Rural-Urban Disparities in Heart Disease: Policy Brief #1)
In 2001, the Centers for Disease Control and Prevention (CDC) published Health, United States, 2001 With Urban and Rural Health Chartbook.  The CDC Chartbook was widely used in directing rural health policy and programming and had not been updated since 2001. The Rural Health Reform Policy Research Center updated the 2001 report to examine the current trends and disparities in urban and rural health.  The analyses were based on the most recent data available (2006-2011) from the National Vital Statistics System, Area Resource File (Health Resources and Services Administration), U.S. Census Bureau, National Health Interview Survey (National Center for Health Statistics), National Hospital Discharge Survey (National Center for Health Statistics), National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration), and the Treatment Episode Data Set (Substance Abuse and Mental Health Services Administration).  Output included aggregate data stratified by geographic region and urbanization level.   

Characteristics, Utilization Patterns, and Expenditures of Rural Dual Eligible Medicare Beneficiaries
Dual eligible beneficiaries are known to have a higher disease burden: a higher proportion of dual eligible beneficiaries are disabled, have three or more chronic conditions, report being in fair or poor health or report difficulties with activities of daily living. As a result, Medicare per capita expenditures for dual eligible beneficiaries are nearly double those for other Medicare beneficiaries. The Affordable Care Act (ACA) includes several provisions aimed at improving care and reducing costs of care for dual eligible beneficiaries, including the creation of the Federal Coordinated Health Care Office (FCHCO) and the Center for Medicare and Medicaid Innovation. Located within the Centers for Medicare and Medicaid Services, the FCHCO is tasked with monitoring and improving benefit coordination, expenditures, access, and outcomes of dual eligible beneficiaries. The Center for Medicare and Medicaid Innovation is charged with examining alternative models of care delivery, such as integration of services and joint financing models. 

Intensity of Service Provision for Medicare Beneficiaries Utilizing Home Health Services (Fact Sheet & Full Report)
Medicare pays for home health (HH) services for beneficiaries who are homebound or for whom travel for care would be difficult or detrimental to health. These HH services are paid on a per-episode basis with an episode consisting of all services provided over a 60-day period. Each episode or claim can entail a varying number of visits; payment is adjusted to account for large differences in the number of visits. Patients with ongoing problems can receive more than one episode of care. 

Advancing the Transition to a High Performance Rural Health System (Full Paper & Brief)
Despite decades of policy efforts to stabilize rural health systems through a range of policies and funding programs, accelerating rural hospital closures combined with rapid changes in private and public payment strategies have created widespread concern that these solutions are inadequate for addressing current rural health challenges.  This paper presents strategies and options that rural health providers may use in creating a pathway to a transformed, high performing rural health system, which are then categorized into four distinct approaches.  We elaborate each approach, and discuss a related set of public policy implications that should be considered when following each strategy.  We follow the discussion of policy implications with four demonstration ideas that reflect the essential elements of each strategic approach in achieving the aims of a high performing rural health system.

The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs
This policy brief describes obstetric staffing patterns in rural hospitals in nine states by Critical Access Hospital (CAH) status. The purpose of this study was to examine current obstetric practice models in rural hospitals, with a goal of providing timely and useful information to rural hospitals with obstetric care units regarding the obstetric workforce and to inform policymakers involved in shaping healthcare about the context in which rural hospitals operate.

Rural-Urban Differences in Continuity of Care among Medicare Beneficiaries
In response to the Affordable Care Act and other reforms in the health care market, new models of care are being tested and implemented across the country. Care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments depend on linkages between different types of health care providers to ensure continuity of care. To addresses concerns that health care in rural areas may be more fractured and thus a difficult place for these models to succeed, we measured continuity of care using detailed data on a sample of Medicare beneficiaries from 2000-2009. 

The Journal of Rural Health
Winter 2015 edition of the National Rural Health Association's professional journal.

Nurse Staffing Levels and Quality of Care in Rural Nursing Homes
Current federal minimum staffing levels for certified nursing homes require one RN for at least eight hours per day, seven days per week, and one licensed nurse (RN or LPN) on duty the rest of the time. State minimum staffing level requirements for nursing facilities vary considerably. Consequently, nurse skill mix and nurse staffing levels per resident may vary significantly across facilities, making it important to consider these variables. 

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Mark Your Calendar

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

February 26: Impact of a Small Rural Hospital or Critical Access Hospital - webinar
March 26: Impact of a Rural Health Network - webinar
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
April 30: Impact of a Community Health Center (FQHC) or Rural Health Clinic - webinar

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Community Commons
Website provides reports, maps and tools to strengthen planning and grant applications to help improve community outcomes.

Hotspotting Toolkit
Hotspotting is a data-driven process for the timely identification of extreme patterns in a defined region of the healthcare system. Hot spotting has been used to show where diseases and hospital admissions cluster in communities and can be used to demonstrate need for funding, and guide targeted intervention and follow-up.

Chronic Users System of Care (CUSOC)
A care coordination and case management program for adults with chronic substance use disorders, mental health diagnoses, and/or complex medical conditions who frequently utilize emergency departments and the jail system.

Right Side Up Falls Prevention
A falls prevention program for adults over the age of 65, with in-home assessments provided by interdisciplinary healthcare professionals and students.


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Funding Opportunities

National Health Service Corps
Deadline: March 30
Primary care medical, dental and mental/behavioral health clinicians can get up to $50,000 to repay their health profession student loans in exchange for a two-year commitment to work at an approved NHSC site in a high-need, underserved area.

2015 NURSE Corps Loan Repayment Program
Deadline: February 26, 2015 at 7:30 PM EST
This Program helps address the shortage and distribution imbalance of nurses across the country by offering loan repayment assistance to registered nurses and advance practice nurses, such as nurse practitioners, working at health care facilities and nurse faculty employed at accredited schools of nursing. 

American Apprenticeship Initiative
Deadline: April 30, 2015
The US Department of Labor has announced that $100 million in grants are available to expand registered apprenticeship programs in high-skilled, high-growth industries including healthcare. Approximately 25 grants from $2.5 million to $5 million each will be awarded using funds collected from employers who use H-1B visas to hire foreign workers. 

Perinatal and Infant Oral Health Quality Improvement Expansion Grant Program
Deadline: Feb 27, 2015
Estimated Award Amount: Up to $250,000 per year
This funding opportunity announcement (FOA) solicits applications for the Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Expansion Grant Program, the second phase of the Perinatal and Infant Oral Health National Initiative. The goal of this grant program, as with this multi-phase initiative, is to reduce the prevalence of oral disease in both pregnant women and infants through improved access to quality oral health care. 

Primary and Behavioral Health Care Integration Grants
Application deadline: Feb 27, 2015
Up to $400,000 per year for up to 4 years
The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, is accepting applications for fiscal year (FY) 2015 Primary and Behavioral Health Care Integration grants.  The purpose of this program is to establish projects for the provision of coordinated and integrated services through the co-location of primary and specialty care medical services in community-based behavioral health settings.


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