VRHA Weekly Update
In this Issue  January 23, 2017

VRHA News Virginia News National News Mark your calendar
Resources
Funding Opportunities
VRHA Site

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January newsletter available

 

 

 

VRHA News

2017 Officers

The VRHA Board of Directors held their first meeting of the calendar year and elected the following officers for 2017

  • President - Summer Sage
  • Vice President - Maggie Bassett (incumbent)
  • Secretary - Steve Sedlock
  • Treasurer - Mike Zodun
Congratulations to our new officers and a big "Thank You" to outgoing President Chuck Carr and outgoing Secretary Ashley Chapman!

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Join a Committee!

With the new year and new officers, VRHA is looking for new committee members.  Please consider serving VRHA in one of the following capacities:

  • Advocacy
  • Governance
  • Student Development
  • Grantwriting
  • Finance
  • Membership


Contact VRHA Executive Director Beth O'Connor for more information.
 

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Members in the News

By Emily Brown

After 25 years with Nelson County’s Blue Ridge Medical Center, CEO [VRHA member and former board member] Peggy Whitehead has decided it’s time to tackle some new endeavors, announcing she will retire by fall of this year.

Whitehead began her work at BRMC as a community organizer on the Rural Health Outreach team, which still is one of the center’s multiple outreach initiatives, in 1991. In that position, Whitehead said she and a few others worked to “engage people more” and help them understand “that preventive health care is important” by going door-to-door to talk with residents of the county. They even tested residents’ blood sugar and blood pressure as they walked the streets of the rural county.

Read the full article.

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Virginia News

Legislative Update

Recently introduced bills which could impact health and healthcare in rural Virginia:

  • HB 2384 Drinking water; lead levels
  • HB 2400 Health insurance; use of drug pricing benchmark value. 
  • HB 2411 Health insurance; reinstating pre-Affordable Care Act provisions.
  • SB 1504 Virginia Health Workforce Development Authority; career pathway. 
  • HB 2457 Health and Human Resources Secretariat; single state agency for data collection and sharing, report. 
  • HB 2458 & SB 1566 Certificate of public need program; established, report.
  • SB 1546 Drug Control Act; adds certain chemical substances to Schedule I.
  • SB 1557 Community health workers; VDH to establish work group to examine risks, etc. 

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The Cost of Repeal

By Chad Stewart - Commonwealth Institute

Repeal of the Affordable Care Act would bring significant increases in the number of people without insurance and the loss of both substantial amounts of federal funding and important insurance protections for millions of Virginians.

New estimates from the Urban Institute indicate that if a repeal bill was to be passed and signed by President Trump, ending most provisions of the Affordable Care Act by 2019, 685,000 Virginians would lose their health coverage, leading to a 79 percent increase in the number of uninsured. Key drivers of this marked increase are the disruptions to the nongroup insurance markets and the loss of Medicaid coverage. This would bring the total number of uninsured to over 1.5 million state residents.

This would be a major departure from trends in recent years in Virginia that have seen substantial drops in the number of people without insurance.

Read the full article.

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Key Budget Choices

From the Commonwealth Institute

The House Appropriations and Senate Finance committees are currently considering the governor's proposed amendments to the 2016-2018 budget (FYs 2017 and 2018). We've put together a summary level assessment of certain key changes in general fund revenue and spending in the proposal.

When the House and Senate committees release their budgets later in the legislative session, we'll update this report to show all three proposals in an easy to read side-by-side format. You can also find the pdf on our Web site.

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National News

Dealing with Closures

By Elly Yu - WABE

Cindy Jones still can’t help but think about the timing of things. Stewart-Webster Hospital, the place she and her family had gone to for years, closed in March of 2013. A month later, her husband Bill suffered a heart attack.

She called an ambulance, which arrived about 15 minutes later, she said. They took him to a hospital in Cuthbert, Georgia, about 25 miles from her Lumpkin home. Her husband was pronounced dead there. He was 52 years old. She said she feels like they lost time traveling to the hospital, and would have taken him to their local hospital, which was 9 miles away, had it still been open.

Stewart-Webster Hospital is one of five rural hospitals in Georgia that have closed since 2013, and there are many other hospitals struggling to keep their doors open. The Georgia Department of Community Health ranked the state’s neediest rural hospitals this month for a program intended to lure donations to the hospitals.

Read the full article.

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Protecting Tap Water

By Laura Ungar - USA Today

Federal and state governments must do more to protect the health of rural Americans in communities where drinking water may be contaminated by lead or not even tested for the brain-damaging toxin, lawmakers and environmental advocates said in response to a USA TODAY Network investigation.
 
The investigation found the United States' drinking water enforcement system doesn’t make small utilities play by the same rules as large ones, exposing millions of Americans to lead-tainted or untested water. About 4 million Americans get their water from small operators who skipped required tests or didn’t conduct them properly, according to an analysis of records from the federal government and all 50 states. The investigation also revealed that about 100,000 people get drinking water from small utilities that discovered excessive lead contamination, but failed to treat the water to remove it even though the problem is known by state and federal regulators assigned to keep water clean and safe.
 
“The moral justice on this is really clear,” said Ruth Ann Norton, president and CEO of Green & Healthy Homes Initiative. “American kids don’t live only in Baltimore or only in Philadelphia or other big cities. They live in West Virginia and West Texas and Oklahoma too….These have been wholly overlooked communities.”

Read the full article.
 

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Oral Health

From the National Rural Health Association

The National Rural Oral Health Initiative is the combined effort of NRHA and the DentaQuest Foundation to highlight best practices and to improve the oral health disparities in rural America through policy, communications, education and research activities.

NRHA is accepting submissions about rural oral health best practices and models for access to care, innovative collaborations, public-private partnerships, reimbursement methods and workforce. Complete an application and send it to Lolita Jadotte by Jan. 26.

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Rural Publications

Rural health service planning: the need for a comprehensive approach to costing
The closure of rural maternity services in industrialized countries is underscored by assumptions of efficiencies of scale leading to cost-effectiveness, with scant evidence to support this. To clearly understand the cost-effectiveness of rural services we must take the broadest societal perspective to include not only health system costs, but also those costs incurred at the family and community levels.

Teen Birth Rates for Urban and Rural Areas in the United States
Teen birth rates have demonstrated an unprecedented decline in the United States since 2007. Declines occurred in all states and among all major racial and Hispanic-origin groups, yet disparities by both geography and demographic characteristics persist. Although teen birth rates and related declines have been described by state, patterns by urban–rural location have not yet been examined. This report describes trends in teen birth rates in urban (metropolitan) and rural (nonmetropolitan) areas in the United States overall and by state from 2007 through 2015 and by race and Hispanic origin for 2015.

Reassessing Financial Peer Groups for Critical Access Hospitals
Policy brief analyzing the influence of hospital, geographic, and community characteristics on the financial performance and conditions of Critical Access Hospitals (CAHs). Discusses the current factors of net patient revenue, government ownership, provision of long-term care, and operation of a Rural Health Clinic (RHC), which are used to determine peer groups for the Critical Access Hospital Financial Indicators Report (CAHFIR).

Rural veterans may not be receiving the mental health treatment they need 
Living in a rural area, for all its benefits, can come with some specific challenges.  An important one can be access to services such as health care.  This can be especially true for specialty services like behavioral health care.  Serving those with unique health care needs requires new approaches when large specialty health care providers are far from home.  For rural veterans, this means improving access to quality care.

Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
Medicare Accountable Care Organizations (ACOs) continued to spread in non-urban counties. This policy brief provides an analysis of the differences in ACO performance on the quality measures among the Medicare Shared Saving Program (MSSP) ACOs with varying levels of rural presence. We classified ACO geographic categories as urban, mostly urban, mixed, and rural based on county location of ACO providers and county Urban Influence Codes.
Additional Resources: Spread of Accountable Care Organizations in Rural America Brief No. 2016-5; Characteristics of Rural Accountable Care Organizations (ACOs) – A Survey of Medicare ACOs with Rural Presence Brief No. 2015-8

The Impact of the Low Volume Hospital (LVH) Program on the Viability of Small, Rural Hospitals
Intro: The purpose of this research was to investigate the financial experience of LVHs in comparison to other rural hospitals. Methods: Descriptive and bivariate statistics (non-parametric equality of medians, Wilcoxon rank-sum, t-test and chi-square) were used to identify rural LVHs, compare rural LVH characteristics to those of rural non-LVHs, and to simulate the potential profitability consequences of changes to the LVH program. Results: Based on this analysis, only one percent of current LVHs would continue to qualify for the LVH adjustment under the 2005 standards. Conclusion: Without additional action from policymakers, the ACA LVH program will expire on October 1, 2017, and the program will revert to the original 2005 standards. Allowing the LVH program to revert to the 2005 standards is likely to have a negative financial impact on LVHs and could impair access to care for Medicare beneficiaries residing in more isolated rural areas.

The Financial Importance of the Sole Community Hospital Payment Designation
In 1983, Congress created the Sole Community Hospital (SCH) program to support small rural hospitals for which “by reason of factors such as isolated location, weather conditions, travel conditions, or absence of other hospitals, is the sole source of inpatient hospital services reasonably available in a geographic area to Medicare beneficiaries.”The purpose of this study was to assess the financial importance of the Sole Community Hospital (SCH) program by investigating: 1) the proportion of SCHs that was reimbursed at the hospital specific rate between 2006 and 2015; 2) the profitability of providing services to Medicare patients in SCHs between 2006 and 2015, and; 3) the financial consequences if the SCH program had not existed in 2015. Conclusion: If the SCH program did not exist, the study findings suggest that there would be: 1) significant financial consequences for most SCHs, and 2) geographic variation in the magnitude of the financial consequences. 

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Mark Your Calendar

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

January 24: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Richmond
January 30: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Fairfax
February 1: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Winchester
February 3: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Harrisonburg
February 5-8: Rural Healthcare Leadership Conference - Phoenix, AZ
February 7: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Salem
February 7-9: 28th NHRA Rural Health Policy Institute​ - Washington, DC
February 9: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Radford
February 13: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Wise
February 15: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Abingdon
February 17: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Danville
February 21: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Lynchburg
February 23: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Charlottesville
April 2-4: MATRC Telehealth Summit - Leesburg

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Resources

Telehealth Fact Sheets
Developed with input from the NOSORH membership, Educational Exchange Committee and the Telehealth Resource Centers, focus on five different areas related to commonly asked questions by rural communities.

Access to Care for Rural People with Disabilities Toolkit
This new toolkit, developed by the University of Minnesota Rural Health Research Center, provides information, strategies, and resources to help rural communities improve access to care for people with disabilities. Browse program models and examples, and learn how to implement, evaluate, and sustain a program in your community and disseminate program results. 

Model Program: STAIR (Skills Training in Affective and Interpersonal Regulation)
A 10-week telemental health program for rural women veterans to reduce PTSD and increase social engagement. 

Model Program: Telepsychology-Service Delivery for Depressed Elderly Veterans
Telepsychology-Service Delivery for Depressed Elderly Veterans compared providing behavioral activation therapy via telehealth and face-to-face for those with major depressive disorder. 
 
USDA Rural Development: 2016 Progress Report
Highlights the investments U.S. Department of Agriculture (USDA) Rural Development (RD) has made to promote community and economic development in 2016, many of which impact the overall health and safety of rural Americans. Provides state-by-state statistics, funding totals for RD programs, and highlights a specific RD program from each state. Includes information on RD funding for Puerto Rico, the U.S. Virgin Islands, and the Western Pacific.

Value-Based Care Assessment Tool
Online tool that assesses 121 different value-based care capacities in eight categories, and creates a value-based care readiness report that can be used to support strategic planning. Tool is designed to be used by your health care organization's (HCO) senior leadership team, and takes roughly 1.5 to 2 hours to complete.

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Funding Opportunities

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

Culture of Health Leaders
RWJFprogram provides cross-sector leadership development based on evidence, informed by experience, and grounded in principles of equity and social justice. These principles inform all aspects of the program design, tools, recruitment, implementation, evaluation, and dissemination—and more importantly, they guide how the program will be in relationship with participants.
Deadline: February 15

Choosing Care Challenge
RWJF challenge is your opportunity to help patients identify and locate health care services for their needs. Patients often walk away from a visit to their physician perplexed and too overwhelmed with to-dos to take the important next steps. Physicians give important instructions regarding medications or visits to specialists, but every insurance plan and neighborhood offers different options. Patients need help finding the most accessible and affordable services based on their location and insurance plan.
Deadline: March 13

Health Policy Research Scholars
RWJF program to create a large cadre of diverse doctoral students from a wide variety of research-focused disciplines—students whose research, connections, and leadership will inform and influence policy toward a Culture of Health. Specifically, we aim to recruit doctoral students from a variety of field/disciplines (e.g., urban planning, political science, economics, ethnography, education, social work, sociology) who are training to be researchers. For the 2017 cohort, the Health Policy Research Scholars program will enroll up to 50 scholars interested in learning to translate their research into health policy and who are from underrepresented populations and/or disadvantaged backgrounds.
Deadline: March 29

Lowe's Toolbox for Education Program
Provides grants for school improvement projects, including school gardens, physical fitness areas, walking trails, and meeting the basic needs of students.
Application Deadline: Feb 9, 2017 

AHRQ Small Research Grant Program (R03)
Supports different types of health services research projects, including pilot and feasibility studies; secondary analysis of existing data; small, self-contained research projects; development of research methodology; and development of new research technology. Rural and frontier areas are considered a priority population.
Application Deadline: Feb 16, 2017 

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