VRHA Weekly Update
In this Issue  August 7, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Summer Newsletter





A Nurse for Every School?

By Mark Tenia - WRIC

A statewide petition is being passed around in an effort to get a nurse in every public school in Virginia. Meanwhile, critics have said the decision should be left to local school boards who may not have the funds to staff a nurse at every school. Read the full article.

What are your concerns regarding school health nursing in rural Virginia?

Come join the discussion at the Virginia Rural Providers Conference during the breakout session led by ​
Tracy White, Virginia Department of Education.

Event will be held October 25 & 26 in South Boston, VA.  Click the logo to the right for full details.

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Members in the News

By Evan Sweeney - Fierce Healthcare

The University of Virginia Health System is shaving down the time it takes to get stroke victims necessary treatment by connecting them with neurologists before they even arrive at the hospital.

Building on its robust telestroke initiatives, the health system has recently connected EMS providers with the hospital’s stroke team while a patient is in the ambulance to reduce the time it takes to receive treatment. The treatment takes the form of a clot-busting drug known as TPA, [VRHA member] Karen S. Rheuban, M.D., director of the University of Virginia Center for Telehealth told members of a Senate Subcommittee on Communications, Technology, Innovation and the Internet. 

“Our stroke neurologists are actually evaluating patients the moment they step into the ambulance and traverse the distance to UVA so that it can reduce the time for treatment,” she said.

Read the full article.

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More Members in the News

By Rachel Hicks - Roanoke Times

The region’s public mental health agencies plan to hire parents experienced with the system to help others in similar situations. The Blue Ridge, New River Valley [a VRHA member] and Mount Rogers behavioral health agencies will share in a three-year, $3 million grant from the Virginia Department of Behavioral Health and Developmental Services to get parents involved in supporting families.

James Pritchett, executive director of New River Valley Community Services, said the three agencies hope to each have one parent peer support partner hired by the end of the summer.

Read the full article.

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Virginia News

Coal Fatailities Up

By Gary Bentley - Daily Yonder

In the first seven months of 2017 there have been 10 coal-mining fatalities in our country. The year is just past the halfway mark, and there have already been more deaths this year than in the entire year of 2016. As of right now, we are on track to record more coal-mining fatalities this year than in the previous four years. With coal employment being at an all-time low, that can mean a few things: miners are being more careless, companies are cutting back on safety protocol and maintenance, or safety inspectors at both the state and federal level are cutting back on the attention given to each mine.

Now, after the presidential election, we have the president and Republicans in Kentucky, Ohio, West Virginia, Virginia, plus coal lobbyists and coal-corporation billionaires fighting to repeal a rule that would strengthen enforcement of safety standards on mines that repeatedly violate safety rules. The rule they want to set aside came after one of our nation’s most recent and largest mining disasters — the 2010 Upper Big Branch explosion which killed 29 miners in West Virginia. Similar regulation took place after the Scotia Mine Disaster of 1976, which happened in my home county of Letcher County, Kentucky. Shortly after that disaster, Congress and President Jimmy Carter enacted the Federal Mine Act of 1977, which revolutionized mine safety regulation and has protected the lives of miners ever since.

Read the full editorial.

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Needle Exchange Launch

By Katie O'Connor - Richmond Times-Dispatch

Dangerous infections are surging throughout Virginia as a wave of hepatitis C continues to spread alongside the opioid epidemic, and an HIV outbreak could be around the corner. But state officials are hoping to curb the rise in the deadly infections by swapping out injection drug users’ dirty needles for clean ones.
On July 1, a new law legalizing syringe services programs — also known as needle exchanges — went into effect, but none has yet been started. The state Department of Health is awaiting applications from eligible jurisdictions before implementing the programs.

Read the full article.

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Hospital Merger

By Hannah Story - WDBJ7

A name change and new signs for two hometown hospitals as they officially become one regional system August 1.
Both the Danville Regional Medical Center and Martinsville Memorial Hospital will no longer be referred to as such. Instead, they will be SOVAH Health, and each hospital will be its own branch.

Read the full article.

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National News

Opioid Epidemic:Testing the Limits

By Zachary Toliver - Rural Health Information Hub

Opioids have seeded their way into every community and social class across the country. In rural areas, the epidemic is challenging the limits of healthcare delivery systems. 

As the CEO of Margaret Mary Health (MMH) in Batesville, Indiana, Tim Putnam has seen first-hand the effects of opioid use in a rural community. From overdose, to blood-borne infections, to the need for treatment, MMH has been struggling to keep up with the increasing needs. In 2014, the hospital in the town of 6,500 people documented 34 cases of Hepatitis C, more than triple the previous year’s number.

That same year, MMH had 27 overdose cases. According to the Centers for Disease Control and Prevention (CDC), the rate of death from opioid-related overdoses is 45 percent higher in nonmetropolitan counties.

Read the full article.

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IRF and SNF Final Rules 

From the American Hospital Association

The Centers for Medicare & Medicaid Services late today issued final rules for inpatient rehabilitation facilities and skilled nursing facilities for fiscal year 2018. In accordance with the Medicare Access and CHIP Reauthorization Act of 2015, payment rates for both settings will be updated by 1.0% relative to FY 2017. 

For IRFs, this represents a $75 million increase while SNFs will receive an increase of $370 million. Regarding the IRF presumptive test for demonstrating 60% Rule compliance, CMS has finalized some of the changes as proposed (such as the major multiple trauma codes), modified the original proposal for others (such as the traumatic brain injury and hip fracture codes), and withdrawn some proposed changes (such as for "unspecified codes" and "G72.89-Other specified myopathies"). 

​CMS did not finalize the removal of any codes that count under the presumptive methodology. CMS also finalized its proposal to eliminate the 25% penalty levied on late patient assessment reports. In addition, in response to concerns by stakeholders, including AHA, CMS has decided to not finalize the addition of several new standardized patient assessment data elements to the IRF and SNF quality reporting programs. CMS did finalize its proposals to revise the current quality measure related to pressure ulcers and to remove the all-cause unplanned readmission measure from both QRPs, and also finalized proposals regarding program logistics for the SNF Value-Based Purchasing program. The rules will take effect Oct. 1. 

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Be a Rural Health Fellow!

From the National Rural Health Association

NRHA is now accepting applications for its year-long Rural Health Fellows program that develops leaders who can articulate a clear and compelling vision for rural America. The program aims to educate and inspire a networked community of rural health leaders who will step forward to serve key positions in the association, affiliated rural health advocacy groups and local and state legislative bodies. 

Each year, NRHA selects up to 15 highly motivated individuals who have proven their dedication to improving the health of rural Americans through their educational or professional experience. Please share this opportunity, as the deadline is Aug. 31.

Editor's note:  VRHA is proud to have 4 members among the Rural Health Fellows alumni.  Carole Pratt, James Tyler, Janice Wilkins, and Bob Alpino.

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Rural Publications

Issues Confronting Rural Pharmacies after a Decade of Medicare Part D
The financial viability of small rural pharmacies became a concern following the advent of Medicare Part D in 2005. Previously receiving payment directly from Medicare based on charges, pharmacies now are reimbursed by private insurance plans per the terms of contracts offered by those plans. There was a significant increase in the number of rural pharmacies that closed following the implementation of Part D, but that rate of closures has moderated in recent years. This brief assess the issues that threaten the sustainability of small rural pharmacies after more than 10 years of experience with Medicare Part D.

Rural Opioid Abuse Prevention and Treatment Strategies: The Experience in Four States
Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, North Carolina, Vermont, and Washington State, this qualitative study explores promising state and community strategies to tackle the opioid crisis in rural communities and identifies rural challenges to the provision of OUD prevention, treatment, and recovery services. 

Is urban-rural location associated with weight status in school children? 
This study utilised FITNESSGRAM data to evaluate differences in overweight and obesity prevalence across different gradations of rurality. Results suggest that students in suburban environments demonstrate lower levels of overweight and obesity than urban and rural counterparts. 

Telepharmacy Rules and Statutes: A 50-State Survey
Telepharmacy is increasingly seen as a valuable tool to provide important clinical services to remote and underserved areas of the country. Since 2001, when North Dakota became the first state to enact regulations allowing the use of telepharmacy, a number of states have established rules and statutes specifically authorizing dispensing medication to patients via technological means, explicitly not requiring direct contact with a pharmacist. 

Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply
Maldistribution of the primary care workforce remains a key problem characterising geographically large countries like Australia and the USA. This study found that rural recruitment and retention of doctors is influenced by a rural town's amenity (e.g. local community infrastructure such as housing, schools, health facilities and transport), not just professional issues (e.g. after-hours support and locum relief). This evidence is important in understanding the role of place characteristics and rural population dynamics in the recruitment and retention of rural doctors.

Medical Barriers to Nursing Home Care for Rural Residents
As the U.S. population ages and the total number of people with disabilities increases, the need for long-term care is growing. However, supply has not kept pace with demand for long-term care, including nursing home care, particularly in rural areas, where the population is aging at a faster rate than the rest of the country and where nursing homes are sparser.

Changes in the Supply of Physicians with a DEA DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder
The opioid abuse epidemic is a significant public health problem today. Rural populations face challenges in accessing treatment. More than half of rural counties nationally lack a physician with a Drug Enforcement Agency (DEA) waiver to prescribe buprenorphine, a medication-assisted treatment that can be provided in an office based setting. 

The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
Using data from the 2011-2012 National Survey of Children’s Health, this study examined rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP and those covered by private insurance. Findings indicate that public coverage supported access to care for low-income rural children and low-income rural families reported fewer problems paying medical bills for their child’s care. CHIP is up for reauthorization in 2017 and decisions about the program’s future should consider the potential implications for affordability of healthcare services among rural children. 

Adverse Drug Events in Rural Hospitals
The first brief, Identifying Adverse Drug Events in Rural Hospitals: An Eight-State Study, analyzes the prevalence of Adverse Drug Events (ADEs) in rural hospitals, including both CAHs and rural PPS hospitals, related to four categories of drugs: steroids, antibiotics, opiates / narcotics, and anticoagulants in 2013 for eight states. It also examines whether or not these hospitals' ADE rates varied based on hospital characteristics.  The second brief, Resources to Reduce Adverse Drug Events in Rural Hospitals, provides resources that could be used to decrease Adverse Drug Events (ADEs) in rural hospitals. 

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Mark Your Calendar

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

August 10:Driving Individual and Population Health Improvements Using Data Analytics - webinar
August 16: A Focus on Suicide Prevention in Rural Communities  - webinar
September 7: Empowering a Rural Community to Create a Culture of Health - webinar
October 25 & 26: Virginia Rural Providers Conference - South Boston, VA

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Model Program: Outer Cape Health Services Community Resource Navigator Program
The Community Navigator program acts as the “glue” that helps clients access services in a coordinated fashion. Through conversational tools, Community Navigators assess clients’ social determinants of health and connect them to the appropriate services and treatments.

Model Program: Health Motivator Program
The Health Motivator Program in West Virginia provides educational materials to designated Health Motivators in senior centers and community groups, who then lead their groups in monthly educational activities.  

Model Program: Love Your Heart
Love Your Heart trains local organizations throughout rural West Virginia to host community events about heart health. 

Model Program: Project Renew
Project Renew provides naloxone training and certification to first responders, healthcare staff, and laypeople in West Virginia in order to reduce the number of deaths from opioid overdose. 

Rural Tobacco Control and Prevention Toolkit
This new toolkit, developed by the NORC Walsh Center for Rural Health Analysis, provides information, strategies, and resources to help rural communities implement tobacco control and prevention programs. Browse program models and examples, and learn how to implement, evaluate, and sustain a program in your community and disseminate program results. 

Rural Health Snapshot (2017)
Disparities in health status and access to healthcare exist between people living in rural areas and those in urban areas. The Rural Health Snapshot (2017) displays selected indicators of access to healthcare, health behavior/risk factors, and mortality rates, comparing rural to urban residents. 

After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
This paper describes opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from centering on inpatient hospital-based care to new models of care delivery in rural places. Communities with hospitals that are vulnerable to closure may also find the approaches outlined here constructive when considering options for optimal care delivery. The health services delivery options are synthesized into two categories: currently available options under existing Federal and State laws governing healthcare structures and payments, and new ideas that are policy options under consideration introduced by various policy stakeholders in response to the crisis that closures have created for many rural communities. The policy options under consideration would promote delivery arrangements that require new laws and/or Federal and State regulations and payment arrangements. 

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Funding Opportunities

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

Insurance Enrollment Assistance
Notice is hereby given by the Virginia Department of Health, Office of Purchasing and General Services of its intent to solicit proposals from qualified contractors to provide Insurance Enrollment Assistance statewide.  Copies of RFP#: VDH-18-611-0002 may be obtained by contacting Nancy Sconzo at nancy.sconzo@vdh.virginia.gov
Sealed Proposals will be received until 2:00 p.m. August 22, 2017 by the Virginia Department of Health, Office of Purchasing and General Services located on the 12th floor, 109 Governor Street, Richmond, Virginia 23219.

Incentive Grants for Pharmacy Practitioners, Students, and Community Practice Residents
Offers pharmacists seed money to implement or support an innovative patient care service within their pharmacy practice.
Application Deadline: Sep 1, 2017 

Foundation for Rural Service 
Grants to nonprofits seeking to create programs that promote business development, community development, education, or telecommunications in rural communities served by the National Telecommunications Cooperative Association (NTCA) members. Awards range from $250 to $5,000. Preference will be given to proposals that foster collaboration and community engagement, and that can be fully funded by the grant or have 75 percent or more of the project currently funded.
Deadline: September 15, 2017

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