Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  August 29, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities






Specialty Care in Rural Communities

How do you get specialists into your community? How do you provide access to specialists when they aren't there?

Wendy Welch, Southwest Virginia Graduate Medical Education Consortium Executive Director & Tony Lawson, Mountain Empire Program of All Inclusive Care for the Elderly (PACE) Program Director will provide a review of national best practices on recruiting specialists into rural communities followed by a roundtable discussion on how people in rural areas can gain access to specialists.

Click the conference logo for event details. 

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VRHA Annual Conference
Abingdon, VA  
October 19 & 20

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VT Student Club!

VRHA has a new student club at Virginia Tech.  The club plans to raise awareness on rural health issues and serve as a resource to students considering health professions careers.

Congratulations to founding members Haley Meade and Alex Robinson!

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Rx Drug Abuse Forums

VRHA in collaboration with One Care of Southwest Virginia is pleased to announce a free CME opportunity for healthcare providers.  The Forum on Prescription Drug Abuse for Healthcare Providers will be offered at four locations around the Commonwealth:

September 10: Lynchburg
September 11: Midlothian
September 24: Abingdon
September 25: Blacksburg
There is no registration fee for this event.  However, attendee space is limited, so early registration is essential. Lunch will be provided at no charge.

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Virginia News

Medicaid Costs 

From the Daily Progress

This cannot be good news for Democrats desiring to expand Medicaid. The Centers for Medicare and Medicaid Services reports that the cost of expansion under the new federal health-care law is rising far more than expected. That cost was $6,366 per person for 2015 — nearly 50 percent higher than projected.

The new information seems to justify Virginia Republicans’ steadfast refusal to expand Medicaid, which helps provide health care for the poorest among us. Republican lawmakers said they feared that the cost would be far too expensive for the commonwealth to handle.

At the same time, the report might indicate that those who are enrolling are sicker than anticipated — in which case, they desperately need the care offered under Medicaid. From the perspective of need, rather than availability of resources, it might be argued that rising costs demonstrate a greater need than we knew — and that a compassionate society would meet that need.

In fact, researchers don’t know exactly what is driving the increase.

Read the full editorial.

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Groceries for the Underserved

Dan Heyman - Public News Service

A new poll finds Virginia voters strongly support a state fund to help bring grocery stores to underserved communities.

Allie Atkeson, campaign manager of the Voices for Healthy Kids program with the American Heart Association, says the program found voters are especially concerned about the half million Virginia children who live in low-income communities with limited supermarket access.

Grocery stores in small towns and poor city neighborhoods often survive on extremely thin profit margins. 

Read the full article.

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Close to Home

By Christopher Cheney - Health Leaders Media

Hospitals in rural areas of the country are feeling a sharp financial pinch in states that have not expanded their Medicaid programs under the Patient Protection and Affordable Care Act. 

Community hospitals in rural counties of Tennessee, one of the states that have opted not to embrace Medicaid expansion, are facing financial pressure that could be relieved if more of their low-resource patients had Medicaid coverage. "In our health systems, they manage it. They have figured it out. Where it's really hitting is our rural hospitals," says Craig Becker, president of the Tennessee Hospital Association. "We've lost six rural hospitals in the last year, and we're going to lose another one this year."

In economically disadvantaged Tennessee communities, many nonelderly adults are either reliant on Medicaid for their health coverage or fall into the "self-pay" category, Becker says. "We only get about 5% of payment for self-pay patients."

Read the full article.

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National News

Insurance Squeeze

By Linda Newman - Daily Yonder

The next president will play a role in drafting and implementing a Farm Bill, along with deciding critical new policies on everything from biotech to animal health, trade and commodity prices. Policy areas not typically thought of as “rural,” sometimes play an even bigger role. One such issue, health care continues to affect the lives of every single man, woman and child in our communities.

Health care has long been an issue of seemingly unbalanced odds in rural regions as economic factors and basic geographical restraints have made access to reliable and affordable health care a luxury. In examining sparsely populated markets, large corporations too often see an opportunity to squeeze consumers without having to answer to any competition. One recently released analysis found that in the coming year, a greater number of rural residents will only be able to choose from one insurance plan on Affordable Care Act exchanges. This lack of available options, and thus competition, places all of the power into the hands of insurers ultimately looking to maximize their profits while passing more costs onto the consumer.

Essentially, insurance companies are now picking winners and losers in the health care arena. By deciding who does and does not get access to certain treatments and medications, insurers and the organizations advising them are taking the fate of many rural Americans into their own hands.

Read the full article.

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Peer Support

Participants in Stone County’s treatment court can enroll in Peers Encouraging and Empowering Peers (PEEPs) in Recovery, a peer support center in Reeds Spring, about 20 miles from Branson.  The center connects people with a peer who is farther along in recovery and who can help navigate life without alcohol.  The idea of using peers to help people in recovery is gaining wider acceptance around the country in places battling addiction.
PEEPs’s director Patricia Sams, herself in recovery from alcohol addiction, started the program earlier this year with funding from a federal grant. She said she saw the need for it here in rural southwest Missouri because recovery from addiction can be hard to maintain in a place where “support systems are so limited.”
PEEPS serves a tri-county area in southwest Missouri near Branson with a combined population of around 100,000  and these three counties (Stone, Lawrence and Barry) have some of the higher overdose rates in the state. 

Read the full article.

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Hospital Quality Star Rating Program

By Brock A. Slabach - National Rural Health Association

CMS released to the public on July 27, 2016 Overall Hospital Quality Star Ratings on the Hospital Compare website for short-stay acute hospitals in United States. This follows the trend of quality data transparency at CMS as part of their Value Based Purchasing (VBP) effort, for example Star Ratings for home health, nursing homes and dialysis. Of course, data transparency isn’t new. CMS has been posting on the Hospital Compare website quality data for individual hospitals for years. What is very different now is reducing 64 measures into a single score (stars) between 1 and 5. The analogy here is Reducing the complexity of hospital quality into a hotel star rating isn’t good for the public, nor is it helpful to hospitals, especially those in rural areas.
First, a little bit about the rating system itself. There are total of 64 measures contained within the categories listed below. Each category is weighted in terms of its effect on the overall rating. For example, mortality has seven measures in that category and it is weighted 22% of the overall score. By contrast, timeliness of care has 7 measures, but it is only weighted 4% of the overall star rating.

Read the full article and then come hear Mr. Slabach at the VRHA Annual Conference.

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MACRA Matters

By Janelle Ali-Dinar - RAC Monitor

MACRA isn’t one size fits all; it has a different impact, meaning, implications, and results depending on provider structure – whether you’re talking about an urban or rural health system, an independent or small practice, critical access hospitals (CAHs), rural health clinics (RHCs), or federally qualified health centers (FQHCs). 

  • Some providers won’t face any pressure in the near future to attain a high Merit-Based Incentive Payment System (MIPS) score, because they just won’t be required to do so. The exclusions in the MIPS attestation process include clinicians newly enrolled in Medicare, QPS-qualifying alternative payment model (APM) participants, certain partial qualifying APM participants, and those providers that practice with a low-volume threshold. 
  • As it relates to CAHs, RHCs, and FQHCs, CMS has proposed that services provided at these entities meet a type of criteria to be counted towards qualifying APM professional determination.
  • Due to how these entities are paid under Medicare, RHCs and FQHCs are currently exempted from reporting to MIPS.
  • Many CAHs and other rural hospitals might not participate in MIPS due to the low-volume threshold. Stay tuned, though – the final proposed rule for rural providers might have enhanced changes.

Read the full article.

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Mark Your Calendar

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

September 10: Forum on Prescription Drug Abuse for Healthcare Providers - Lynchburg
September 11: Forum on Prescription Drug Abuse for Healthcare Providers - Midlothian
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO
September 23: Rural Health Funding Summit - South Boston
September 24: Forum on Prescription Drug Abuse for Healthcare Providers - Abingdon
September 25: Forum on Prescription Drug Abuse for Healthcare Providers - Blacksburg
October 18: Rural Health Telecommunication Consortium Kick-Off Meeting - Abingdon
October 18-19:  Rural Health Coding & Billing Specialist Training  - Abingdon
October 19-20: VRHA Annual Conference - Abingdon

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Health Extension Toolkit
Intended for a wide audience and designed as a tool for states to use as they collaborate to improve the quality of primary care practices as well as community health, using a model based on the agricultural Cooperative Extension Service. Includes chapters on engagement, the Health Extension model, primary care, population health, and sustainability, and features profiles on lead states Pennsylvania, New Mexico, North Carolina, and Oklahoma.

Rural Health Research Gateway Videos
Collection of videos featuring rural health researchers discussing their work and describing the role of the federally-funded rural health research centers. 

Stratis Health Rural Palliative Care Impact Report
Report examines palliative care models that have proven to be effective in rural areas of Minnesota and establishes measures to understand ways in which palliative care offers value to patients and promotes community development.

Model Program: North Carolina Council of Churches - Partners in Health and Wholeness 
Integrates healthy living within rural and urban congregations while offering financial support to launch new initiatives. 

Model Program: Pharmacists for Patient Safety Network
A communication network in which pharmacists can identify safety concerns and share solutions. After 1 year of implementation, 30 of the 38 participating pharmacies reported that the network encouraged new safety practices and reinforced existing safety strategies.

CMS Provider eNews:

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Funding Opportunities

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

Rural Capacity Building for Community Development and Affordable Housing Grants
Grants to fund national organizations that can provide technical assistance to local communities. Assistance will be targeted to help communities create thriving community development and affordable housing strategies that will result in healthier homes and communities.
Application Deadline: Sep 13, 2016 

Culture of Health Prize
Awards that honor community efforts and partnerships that are helping people live healthier lives.
Letter of Intent (Required): Nov 3, 2016
Application Deadline: Jan 20, 2017 

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