By Sandy Hausman - WVTF
Rob Marsh has a medical practice in Virginia's Shenandoah Valley. He likes the freedom to open his office at night if a patient gets sick. Marsh wants to make house calls, and he needs to pay a staff that has grown from 2 to 23. But many people in this area lack insurance. The financial pressures of practicing medicine in the 21st century have led more doctors to take jobs with large hospitals and medical practices. Last year, only 17 percent of doctors were in solo practice. Wanting to stay put, but feeling the budget pressure, Marsh decided to add a new source of revenue from a surprising source of patients. About 20,000 truckers pass through Raphine, Va., every day, and the owner of White's Truck Stop asked Marsh to open an office there. At first, the busy country doctor refused.
If the six counties on lower Delmarva were a state of their own, they would have the 13th highest amount of inequality nationwide, according to a Daily Times analysis. No wealth, no health.
Scientifically speaking, the link between income inequality and worse health outcomes isn't as strong as between poverty and health. But study after study, year after year, the case gets stronger. And places like Delmarva, where inequality reigns, get sicker.
The Veterans Affairs Medical Center in Salem was authorized last year to hire 58 doctors, therapists, nurses and support staff so that veterans could more quickly access health care.
Half of the slots have been filled and, since last summer, the local VA clinics have on average reduced the percentage of veterans waiting longer than a month for appointments from 3 percent to 2.21 percent. But the average doesn’t tell the specific story or identify the ongoing challenges, said medical center director Dr. Miguel LaPuz.
Nor do the numbers identify particular problems. For example, the Veterans Administration reports that from September 2014 through February of this year, 390 veterans waited longer than 90 days for an appointment at the Salem VA. But care is not being delayed in all of those cases.
By Diane Calmus - National Rural Health Association
The Senate has passed HR 2, the Medicare Access and CHIP Reauthorization Act, a passed by the House in March that repeals the Medicare Sustainable Growth Rate (SGR) and replace it with a payment system that promotes a higher quality of care. Six amendments were debated and rejected. The bill passed 92-8 with strong bipartisan support.
The passage of this bill marks the end of the need for an annual fix to the SGR formula that would have resulted in an over 21 percent decrease in physician reimbursement for caring for Medicare patients.
HR 2 includes multiple important programs for rural America. The bill includes a two-year extension of rural Medicare extenders such as the Low-Volume Hospital adjustments, Medicare-Dependent Hospital program, work geographic index floor under the Medicare physician fee schedule, current rural and super-rural ambulance add-on payments, and exceptions process for Medicare therapy caps. The bill also extends funding for two years to community health centers, National Health Service Corps and teaching health centers.
The National Rural Health Association applauds the inclusion of so many programs of importance to rural America. NRHA is pleased that Congress is hearing our message about the importance of rural health care and the need for robust support of programs targeting rural health care.
A number of states that had previously refused to expand their Medicaid programs for the poor are reconsidering that policy. They would be smart to embrace expansion as soon as possible to cover millions of people who would be left uninsured if the Supreme Court wipes out federal subsidies for low-income people buying insurance on the federal health exchanges.
The Affordable Care Act originally required all states to expand Medicaid to cover people with an income up to 138 percent of the federal poverty level, or $32,913 for a family of four, but in 2012 the Supreme Court made expansion optional. Twenty-eight states and the District of Columbia have expanded their programs, but 22 have not.
The federal government pays 100 percent of the costs of covering newly eligible people through 2016, shifting down to 90 percent in 2020 and future years. This is a huge benefit to the states, since more health coverage means a healthier population, fewer people losing jobs because of health crises, greater productivity at work, fewer people getting charity care at costly hospital emergency rooms, and less strain on hospital and clinic budgets.
When Ryan Sallans, an activist in the Nebraska transgender community, first went to the doctor in 2005 to talk about what he medically needed to do for his gender transition, his doctor wanted to offer medical help. That was the good news. The disconcerting news was the doctor had to Google the issue first to figure out the best medical advice.
Fortunately, Sallans didn't have any health complications. But his experience left him with a mission. He volunteers to speak with medical institutions, as well as with businesses and colleges, to urge them to be more LGBT inclusive.
For members of the LGBT community who live in more rural and conservative areas like Nebraska, the struggle to get good, or at least up-to-date, medical care may be even more difficult. Without the legal institution of marriage, LGBT Nebraskans typically lack family health benefits, unless their employers provide them to same-sex partners. Even when LGBT Nebraskans have health insurance, they struggle to find providers versed in lesbian, gay, bisexual and transgender heath care needs.
Those of us who work for or live in rural communities have two unique opportunities: advocacy and collaboration. For me, advocacy means acting to have others share your vision. For rural health, that often means confronting the multiple myths embedded not too far below the surface of many opinions. Here are some of my “favorites”:
Rural residents don’t care about local care.
Rural folks are naturally healthy and need less.
Rural health should cost less than urban care.
Or rural health care is inordinately expensive.
And finally, rural quality of care is lower. Urban is better. Rural hospitals and clinics are just Band-Aid stations.
These stereotypes should make your blood boil, and that is good. Advocacy needs passion to fuel it over the long haul that is needed to make a difference. Use that energy to work in your community and with others who have earned your respect for standing up for rural health.
There are many opportunities to advocate for rural health. Pick an issue you care about, commit to making a difference and seek partners with the same passion.
For more information about these and other events, visit the VRHA Calendar
April 22: Value-Based Modifier: Act Now to Avoid Payment Adjustments - webinar
April 30: Impact of a Community Health Center (FQHC) or Rural Health Clinic - webinar
May 28: Impact of a Small Rural Hospital - webinar
May 27: What Suicide Interventions Outside of Health Care Settings Reduce Risk? - webinar
June 24: What Research Infrastructure Do We Need to Reduce Suicidal Behavior - webinar
Military Culture Training for Community Providers Fact Sheet It’s important that all who care for Veterans have a basic understanding of military culture. With the new Choice Program, the signature initiative of the Veterans Access, Choice and Accountability Act of 2014, eligible Veterans have increased access to health care from community-based medical care providers.
Education and Training of the Healthcare Workforce
The training of the health workforce plays a big role in whether students consider, and are prepared for, rural practice. This new topic guide discusses a wide range of strategies, programs, and technologies for training the rural health workforce.
National Health Service Corps Scholarship Program Application deadline: May 7, 2015
Provides scholarships for students pursuing primary care health professions training in exchange for a service commitment in a health professional shortage area.
Health Careers Opportunity Program (HCOP) Application deadline: May 15, 2015
The goal of the Health Careers Opportunity Program (HCOP) is to assist individuals from disadvantaged backgrounds to undertake education to enter a health profession.
NURSE Corps Scholarship Program Application deadline: May 21, 2015
Provides scholarships to nursing students in exchange for a two-year, full-time service commitment (or part-time equivalent), at an eligible health care facility with a critical shortage of nurses.
Now Is the Time Project AWARE-Community Grants
Application deadline: Friday, May 1, 2015
Anticipated Award Amount: Up to $125,000 per year (Up to 70 awards)
The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, is accepting applications for fiscal year (FY) 2015 “Now is the Time” Project AWARE-Community (Short Title: NITT-AWARE-C) grants. The purpose of this program is to support the training of teachers and a broad array of actors who interact with youth through their programs at the community level, including parents, law enforcement, faith-based leaders, and other adults, in Mental Health First Aid (MHFA) or Youth Mental Health First Aid (YMHFA).
Office of Minority Health Partnerships to Increase Coverage in Communities II
Deadline: May 22, 2015, by 5:00 p.m. EDT
Award Ceiling: $200,000 to $250,000
The Office of Minority Health (OMH) at the United States Department of Health and Human Services announces the availability of funds for Fiscal Year (FY) 2015 for the Partnerships to Increase Coverage in Communities II (PICC II) Initiative. The purpose of the PICC II Initiative is to educate racial and ethnic minority populations, including those that are economically and/or environmentally disadvantaged, and immigrant and refugee populations who are eligible for health coverage through the Marketplace, so that they better understand the Marketplace and receive assistance with completion of the application to determine their eligibility and obtain or purchase health coverage offered through the Marketplace.
Preventive Medicine Residency with Integrative Health Care Training Program
The deadline to apply for this opportunity is May 29, 2015. The purpose of the Preventive Medicine Residency with Integrative Health Care Training Program is to improve the health of communities by increasing the number and quality of preventive medicine physicians who can address public health needs and advance preventive medicine practices, increase access to integrative medicine, and increase the integration of these two fields (integrative medicine and preventive medicine) into overall primary care training and practice. Eligible applicants include accredited schools of public health or school of medicine or osteopathic medicine; accredited public or private nonprofit hospitals; state, local or tribal health departments; or a consortium of two or more of these eligible entities. HRSA will award approximately 14 grants totaling $5.4 million annually for a three-year project period (September 1, 2015, through August 31, 2018). Applicants may apply for up to $400,000 per year.
American Legion Child Welfare Foundation
The mission of the American Legion Child Welfare Foundation is to provide nonprofit organizations with a means to educate the public about the needs of children across the United States. The Foundation supports organizations that contribute to the physical, mental, emotional, and spiritual welfare of children through the dissemination of information about new and innovative programs designed to benefit youth, or through the dissemination of information already possessed by well-established organizations. Grant requests should have the potential of helping American children in a broad geographic area (more than one state). The application deadline is July 15, 2015.