Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  October 26, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


October Newsletter





VRHA Conference Presentations

We hope you enjoyed the 2015 VRHA Conference!  Slides from the plenary sessions have been posted on the conference webpage.  Breakout sessions will follow in the next few weeks.

Plenary sessions:

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Members in the News

From the US Department of Health and Human Services

Health and Human Services Secretary Sylvia M. Burwell announced nearly $500 million in Affordable Care Act funding to support health centers nationwide in providing primary care services to those who need them most.  The awards include approximately $350 million for 1,184 health centers to increase access to services such as medical, oral, behavioral, pharmacy, and vision care. Nearly $150 million will be awarded to 160 health centers for facility renovation, expansion, or construction to increase patient or service capacity.

Both of the Virginia awardees are VRHA members!  Congratulations to the Community Health Center of the New River Valley and the Rockbridge Area Health Center.

Read the full press release.

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More Members in the News

By Shannon Muchmore - Modern Healthcare

Much of rural America already resembles the country's future—it's older and sicker.  Take Page County at the northern edge of Virginia's historic Shenandoah Valley, for instance. Despite its proximity to the nation's capital, the population over age 65 has increased by 28% to about 1 in 5 residents over the past decade. The poverty rate in the county of about 24,000 is up 21%. And unemployment stands at 6.9%, significantly higher than the national average.
Access to healthcare for its aging population is crucial, local officials say. And, lucky for local residents, they still have the 25-bed critical-access [VRHA member] Page Memorial Hospital, located in the county seat of Luray. Without it, residents would have to drive at least 45 minutes to an emergency room or for primary and preventive care.
But the hospital's future is threatened by the ongoing cuts to Medicare and the failure of the state to expand Medicaid, officials say. “If you decide to live in a rural community, are you deciding to have a worse outcome if you have a stroke?” asked Dr. Jeff Feit, vice president of population health at the Valley Health system, which manages the hospital and five others along the Virginia and West Virginia border.

Read the full article.

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Virginia News

The Rural Risk

By Massey Whorley - Commonwealth Institute

The 400,000 low-income, uninsured Virginians aren't the only ones struggling to get by because state lawmakers haven't closed the coverage gap. At least half of rural hospitals, and maybe more than that, were in the red last year, according to the Virginia Hospital and Health Care association and confirmed by PolitiFact Virginia.  With so many hospitals struggling, there are bound to be consequences. And there have been.

Back in 2013, Lee Regional Medical Center closed its doors in part because state lawmakers refused to adapt to the changing health care landscape where more people are supposed to have insurance to pay for the care they receive. The closing of Lee Regional hurt the local community and economy. It wiped out 140 good paying jobs. It also left an entire county without a hospital, drastically increasing the drive time for people needing emergency treatment. And it's not as if Lee County is an area flush with physicians and alternative health care options: many uninsured folks from out that way rely on a once-a-year clinic that sets up camp at the regional airport and the occasional visit from a retrofitted RV. In fact, Lee is in the same neck of the woods as Grundy, which has the terrible moniker of Sickest Town in America.

Struggling rural hospitals would be better off if more of their customers had insurance to help pay for the care they receive. One way to help fix that problem is to close the coverage gap, which could help as many as 400,000 low-income, uninsured Virginians get the care they need and make sure hospitals get paid for the services they provide. Had state lawmakers agreed to help them when they first had the chance in 2014, more than $2.8 billion dollars would have been pumped into our economy, largely through our hospitals.

Read the full article.

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Closing Mental Health Gaps

Last year, Virginia’s local and regional jail systems reported 6,787 incarcerated people with mental illness — 1 in 4 of Virginia’s inmates — making jails among the commonwealth’s largest providers of mental-health services.
Virginia has fewer than 1,500 state psychiatric beds. That sounds like a lot of hospital beds, so what’s the problem? At any time, hundreds of discharge-ready patients are occupying those beds because of a lack of community services, such as medication treatment, therapy groups, case managers and housing.
Given the circumstances, it’s not unreasonable to expect that jail staff be trained in handling inmates with mental illness. But we need to ask why there are nearly 7,000 inmates with mental illness in jail. For what other health-care concern do people wind up in jail instead of in a doctor’s office?

Read the full commentary.

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Survey Says...

By Jill Hanken - Healthcare for All Virginians

A new survey of likely voters in five states – Florida, Nevada, Ohio, Pennsylvania and Virginia – shows solid majorities believe the Affordable Care Act is here to stay (64 percent) and that Congress should work to improve the law (71 percent).
Moreover, in all five states, a large majority of voters support closing the health care coverage gap, created when the Supreme Court made expanding Medicaid optional under the ACA. In Virginia, nearly three-quarters of voters (74 percent) said Virginia should accept the federal funding set aside to close the coverage gap, an action that would make health care coverage available for up to 400,000 uninsured Virginians.  
“This latest survey confirms what we continue to hear over and over across Virginia,” said Jill Hanken of the Virginia Poverty Law Center. “Voters understand that their fellow hardworking Virginians need the security of health coverage to get care when they need it, without facing huge medical bills or going into bankruptcy.”

Read the full press release.

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National News

Action Alert!

By Diane Calmus - National Rural Health Association

The Health Resources and Services Administration (HRSA) released the proposed guidance about the 340B program, the long-anticipated so-called “mega guidance.” It’s comprehensive and discusses virtually all aspects of the 340B program. It includes restatements, clarifications, and proposed changes to current 340B policy. Comments are due Tuesday Oct. 27, 2015 and can be submitted online at

NRHA is encouraging everyone with experience with 340B to tell HRSA how important this program is by commenting. Here is the NRHA draft comment letter -  feel free to use this as a basis for your comments.  USE YOUR COMMENT TO TELL YOUR PATIENTS’ AND HOSPITAL’S STORY! Your comments don’t have to be perfect; they simply have to tell your story!

If you have questions, would like help preparing comments, or have a story to share for NRHA’s comment about how important 340B is to your hospital and patients, please email             Diane Calmus. NRHA is happy to help you draft comments and would like to include your information in our letter as well.

Read the full Action Alert.

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Solution to the Crisis

By Diane Calmus - RAC Monitor

Fifty-six rural hospitals have closed since 2010, and 283 rural hospitals are on the brink of closure. Since January 2013, more rural hospitals have closed than in the previous 10 years combined, and the rate at which hospitals are closing is increasing.

The Save Rural Hospitals Act, H.R. 3225, recently introduced by U.S. Rep. Sam Graves (R-Mo.) and Rep. Dave Loebsack (D-Iowa), will stop the flood of rural hospital closures, provide needed access to care for rural Americans, and create an innovative delivery model that will ensure emergency access to care for rural patients across the nation. 

Rural healthcare delivery is challenging. Workforce shortages, older and poorer patient populations, geographic barriers, low patient volumes, and large uninsured and under-insured populations are just a few of the barriers. Rural physicians and hospitals work around many of these barriers to provide high-quality personalized care to their communities. 

The Save Rural Hospitals Act protects all rural hospitals, not just those about to close their doors or choosing to convert to a new delivery model. All rural hospitals face decreasing reimbursements from continued cuts in hospital payments. 

Read the full article and a state-by-state breakdown of the hospital closures.

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Painkillers and Rural Youth

By Gabe Schwartzman - Daily Yonder

A greater likelihood of receiving medical care in an emergency room could be one of the reasons rural adolescents are more likely than urban youth to misuse painkillers, a new study says. Rural residents aged 12 to 17 were 35 percent more likely to have abused prescription painkillers in the past year than adolescents living in large cities.
The report indicates that the types of health services rural teens receive might explain the higher prescription painkiller misuse rates. Rural adolescents are more likely to use emergency room services than urban adolescents, and ER doctors are more likely to prescribe opioid painkillers than physicians in other clinical settings, the study found.
One of the study’s authors, Shannon Monnat, said the research is important, not just because prescription painkiller misuse is unsafe. She said painkiller abuse can lead directly to heroin use – with its greater danger of overdose – when the supply of prescription drugs is cut off.

Read the full article.

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Rural Apps

By Whit Richardson - Portland Press Herald

After using mobile technology to improve health care in some of the world’s poorest places, a local nonprofit program has turned its attention to rural Maine and launched a novel pilot project. Harrington Family Health Center in Harrington, a small coastal community in Washington County, treats some of the state’s poorest and most at-risk populations for chronic health conditions.
Since July, nurses and physicians at the center have been using tablet computers loaded with dozens of medical-related apps that help them treat patients. The apps include searchable medical encyclopedias, a dosage calculator, a pill identifier and a symptom checker, which allows a nurse to input symptoms and immediately get a list of potential conditions. It also has an app that allows a health care provider to enter a patient’s medications and immediately get information on how those drugs interact and potentially dangerous combinations.
For health care providers who commonly see patients suffering from multiple conditions, the help is welcome, said Lee Umphrey, CEO of the health center, which last year treated roughly 3,500 patients over the course of 14,000 visits.

Read the full article.

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Mark Your Calendar

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

October 26: Healthcare Access as a Moral Imperative - Blacksburg
October 29: Safe Prescribing of Opioids Seminar - Salem
November 13: VOHC Conference, Achievable Wellness: Engaging Communities and Clinicians for Better Health - Richmond
December 3: TCI Policy Summit - Richmond
February 2-4: Rural Health Policy Institute - Washington, DC

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Medicare Learning Network e-Provider News:

Grantee Directory: Rural Health Care Services Outreach Grant Program, 2015-2018
Provides contact information and a brief overview of the 60 initiatives funded under the Rural Health Care Outreach Services grant program in the 2015-2018 funding cycle.

Promoting Active Living in Rural Communities
A summary of research, observations, policy statements, and lessons learned from rural active living interventions identifying factors within the rural environment that may contribute to higher rates of obesity in rural children and adults.

Rural Healthy People 2020: A Companion Document to Healthy People 2020, Volume 2
Provides a rural focus for the Healthy People 2020 priorities. Includes overviews of the top rural health priorities ranked 11 through 20 identified by rural stakeholders. (Volume 1 discussed the top 10 priorities.) Topics addressed include: cancer, health education, oral health, quality of life and well-being, immunizations and infectious disease, public health infrastructure, sexual health and family planning, injury and violence prevention, and social determinants of health. Each overview includes reviews of the relevant literature and models that rural communities can use to address the issues.

Small Rural Hospital Transition (SRHT) Project Guide: A Guide for Rural Hospitals to Identify Populations and Shift to Population Health
Helps hospital management teams recognize specific patient populations associated with a higher percentage of total healthcare expenditures and helps hospitals focus their programs on these population groups to improve quality of care, healthcare outcomes, and reduce healthcare costs. Serves as a resource for State Offices of Rural Health directors and Flex Program coordinators to help rural hospitals with transition efforts to value-based payment models.

The State of Obesity 2015: Better Policies for a Healthier America
Reports on obesity-related rates and trends. Identifies federal nutrition, physical activity, and obesity-related policies and programs, including programs targeted to rural areas. 

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Funding Opportunities

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

InterConnection - Discounted Computers for Nonprofits  
Deadline: 12/15/2015
Striving to connect nonprofit organizations and underserved communities around the world to the computers and technology they need.  

Nurse Anesthetist Traineeships 
Awarded to eligible education programs to pay tuition, books, fees and a living stipend to registered nurses who have completed at least 12 months in a masters or doctoral-level nurse anesthesia program.  Special consideration will go to applicant schools whose graduates work in rural and underserved areas.  Closing date for applications is Friday, November 20, 2015.

Cardinal Health Foundation: E3 Grant Program
The Cardinal Health Foundation provides grants for programs that improve healthcare safety and quality. The Foundation’s E3 (Effectiveness, Efficiency, and Excellence in Healthcare) Grant Program supports projects developed by nonprofit healthcare institutions throughout the United States that help healthcare providers implement best practices that can truly transform patient care. For 2016, the focus is on proposals that include some or all of the following criteria: medication safety at transitions across the continuum of care from the hospital to home and ambulatory settings, taking successful work to scale, engaging patients and their caregivers and families, publishing or otherwise sharing outcomes, and finding innovative and sustainable ways to effect long-term change. Multi-year requests of $50,000 per year will be awarded. The proposal deadline is December 4, 2015. 

Postpartum Progress: Climb Out of the Darkness Local Grants Program
The mission of Postpartum Progress is to create healthier families by raising awareness, reducing stigma, providing social support, and connecting mothers to help for perinatal mood and anxiety disorders like postpartum depression. The Climb Out of the Darkness Local Grants Program, offered by Postpartum Progress, supports local nonprofit organizations that offer direct services to mothers or programs that improve services to mothers. Examples of eligible programs include support groups, or those that lead community network development (building up systems of referral between obstetricians/pediatricians/primary care providers or hospitals and reproductive psychiatry specialists). Funding priorities include in-person support groups, especially in locations not yet served; programs aimed at providing support or services to underserved women, (e.g., teen moms, mothers of color, and low-income women); and provider training. The application deadline is November 20, 2015 

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Blacksburg, VA 24060

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