Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  April 25, 2016

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

Spring newsletter

 

 

VRHA News

Members in the News

From NBC29.com

A shortage of primary care doctors across the country is hitting close to home for [VRHA member] Blue Ridge Medical Center in Nelson County. Currently the center serves 9,000 patients annually. Ideally it wants to staff 10 doctors in different specialties, but its primary care department has none, only nurse practitioners.

The center has shortened some daily hours because it simply doesn't have the staff to provide care. At the same time recruiters are trying to lure medical doctors, but say competing with larger health systems is tough.

A national study from the Association of American Medical Colleges says the big reason this a problem is because doctors are retiring. Blue Ridge Medical Center agrees with that assessment. 

Watch the video.

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Virginia News

Senate Expansion Bill

From NBC29.com

The Virginia United States Senators Mark Warner and Tim Kaine joined six of their senate colleagues to introduce the States Achieve Medicaid Expansion Act of 2016.

This new legislation guarantees federal reimbursement of 100 percent of the cost to states for the first three years to expand Medicaid. Nineteen states,including Virginia, have not expanded their Medicaid programs.

Kaine says that the expansion would grant healthcare coverage to 400,000 low-income Virginians while saving the commonwealth more than $150 million. 

See also the related story from WVTF and a research paper from the Robert Wood Johnson Foundation demonstrating that expansion states see significant budget savings and revenue gains. 

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Opioid Bill

From the Office of Congressman Morgan Griffith

The Health Subcommittee today voted on a number of bipartisan bills as part of the House Energy and Commerce Committee’s ongoing efforts to combat our nation’s opioid and drug abuse crisis.  Among the bills passing the subcommittee was the Co-Prescribing to Reduce Overdoses Act (H.R. 3680), legislation introduced by Congressman John Sarbanes (D-MD) to create a grant program for co-prescribing of opioid reversal drugs for patients who are at a high risk of overdose.

Congressman Morgan Griffith (R-VA) successfully included an amendment in the Co-Prescribing to Reduce Overdoses Act.  Griffith’s amendment builds on bipartisan language developed by U.S. Senator Tim Kaine (D-VA) and U.S. Senator Shelley Moore Capito (R-WV) calling on the Department of Health and Human Services (HHS) to develop best practices for prescribing naloxone, a medication designed to counter the effects of an opioid and prevent overdose, to patients who are at an elevated risk of overdose for opioids or heroin.  This would include those who may or may not be in treatment for opioid addiction.  Griffith incorporated technical assistance from HHS into his amendment to ensure these best practices do not cause liability concerns for medical providers.  Additionally, there is no new expenditure associated with the development of these best practices, as HHS would use existing authorizations.

Griffith said, “Too many Americans have been lost to opioid abuse.  While many of these deaths are preventable, as with similar issues, there is no simple fix for this public health crisis.  Accordingly my colleagues and I on the Energy and Commerce Committee have held numerous hearings over the last year to further educate ourselves on opioid abuse, how it is treated, and how to better assist victims, their loved ones, and communities throughout the country.  While I am encouraged by the bipartisan bills that today passed the Health Subcommittee and am pleased by my colleagues’ support of my amendment, we must diligently continue our important work on combating this growing epidemic.”

On March 9, 2015, Griffith led a bipartisan group of his colleagues in sending a letter to Administration officials including Department of Health and Human Services Secretary Sylvia Burwell, Office of National Drug Control Policy Director Michael Botticelli, and Office of Management and Budget Director Shaun Donovan prompting the Administration to propose and put in place new, innovative best practices to integrate naloxone throughout the health care delivery system.

Video of the debate on Griffith’s amendment can be viewed here and Griffith's letter to Secretary Burwell is here.

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ACA Affordability

By Jennifer Tolbert,  Robin Rudowitz, and  Melissa Majerol - Kaiser Family Foundation

Millions of people have gained access to health insurance coverage under the Affordable Care Act (ACA) through Medicaid and the Marketplaces. While research shows that coverage improves access to care and promotes financial stability, issues around access and affordability remain, and are more acute for the low-income population.

To learn more about how low-income individuals have fared with their new coverage, we conducted nine focus groups (three groups with Medicaid enrollees and six groups with low-income Marketplace enrollees) in six states (California, Florida, Maryland, Missouri, Ohio, and Virginia).  Many participants were struggling financially and reported substantial debt (including medical debt). Many had ongoing physical and mental health needs and were accessing health services to treat those conditions.

Read more about the study.

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Close to Home

From the National Rural Health Association

Cancer is epidemic in eastern Kentucky, a result of medical illiteracy, limited access to care, unhealthy lifestyles and poverty. In fact, life expectancy in the region is five years shorter than the rest of the nation. But state health officials are aiming to change that with comprehensive prevention and education initiatives. “The challenge is educating them that they can do something about it, and that I can help them do something about it,” says the Rural Prevention Cancer Center’s Tom Collins, an NRHA member. “You don’t have to get cancer."

Watch the video or read the transcript from PBS News Hour.

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National News

Input Needed

From the Federal Office of Rural Health Policy

As an organization that focuses on rural health, we hope that you will consider responding to this Request for Information (RFI) from the Centers for Medicare & Medicaid Services (CMS) Innovation Center.  We are encouraged by the concepts CMS has laid out in this RFI and the opportunity it creates to think more creatively about how to focus on population health in a way that provides meaningful participation by rural providers.  We encourage rural hospital and clinic experts to offer their perspectives on how a global budgeting approach could be developed that would offer a pathway for key rural safety net providers like Critical Access Hospitals (CAHs) and low-volume rural hospitals to focus on improving health in their communities through more creative and flexible financing.  In this RFI, CMS is explicitly asking for input from rural providers and experts and how one might build a global budgeting system that takes into account the historical financial protections for CAHs and other special designations for rural hospitals like Sole Community Hospitals or Medicare Dependent Hospitals and special billing provisions for Swing Beds and Method II billing for CAH physicians. It will also be important to hear ideas from Rural Health Clinics and rural Community Health Centers as well as post-acute care providers. 
 
We would encourage commenters to see this as an opportunity to think beyond cost-based reimbursement or the traditional fee-for-service arrangements that have offered some protections to ensure access in rural areas but which also create significant challenges in allowing rural providers to truly shape their delivery system to meet local need and improve the health of their service area. In addition, we would encourage rural providers to offer their thoughts to CMS on what sort of incentives could be created to encourage regional partnerships of providers and public and private payers that would ensure meaningful rural participation. 
 
Additional details on the regional budget payment concept will be posted here as they become available.  The RFI can be found here

Comments on the Request for Information should be submitted via e-mail by Friday, May 13, 2016. For more information, please contact regionalbudgetconcept@cms.hhs.gov.
 

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More Input Needed

From the National Rural Health Association

On March 8th CMS released a proposed rule for a CMMI nationwide Medicare Part B medication payment demonstration. This proposed rule would change the methodology for paying for Part B drugs from Average Sale Price (ASP) plus 6%, to ASP plus 2.5% plus a flat rate (which the proposed rule estimates as $16.80). This change would make lower cost medications more profitable at the expense of more expensive drugs. A second phase of the demo a variety of value based purchasing tools. This demo is not voluntary.

The proposed rule estimates the impact for rural hospitals would be an overall 0.3% reduction in Medicare payments (the result of a 2.2% reduction in drug payments). For this reason, NRHA believes rural hospitals must be excluded from the proposed Part B Drug Payment model to avoid additional rural hospital closures and maintain continued access by vulnerable populations. The extraction of $322 million from rural hospitals at a time when 71 rural hospitals have closed since 2010 and 673 additional rural hospitals are vulnerable to closure is unacceptable. Particularly concerning is that 65% of the rural closures have occurred to PPS hospitals, which are impacted by this program. Recent research bears out this concern, showing Medicare Dependent Hospitals (MDH) with median operating margins of less than -2%. Generally, while urban profits have increased, rural profits have decreased since 2012.

NRHA encourages your organization and any rural hospitals, especially the PPS hospitals impacted by this policy, to submit comments regulations.gov before May 9. NRHA’s letter is attached and can be used as a template, though hospitals are encouraged to add specific examples that demonstrate how their patients would be impacted by this change.

We encourage you to pass this information along to any rural hospitals you work with. We are particularly concerned that the hospitals that this will hurt the most will be unaware of the change until it’s too late. We appreciate your help in reaching out to as many hospitals as possible.

Deadline to submit comments via the Federal Register is May 9; a sample letter has been provided by NRHA for your convenience. If you have any questions or would like assistance in preparing or submitting your comment letter, contact Diane Calmus (202-639-0550).
 

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Home Visits 

The USDA budget summary shows a request for $20 million for home visiting under the National Institute of Food and Agriculture. Home Visits for Remote Areas Program (HVRAP) – The Budget includes $20 million for a new competitive grants program that provides support to high-risk, high-need maternal, child, and family health in remote rural areas and Indian country.

This program will complement the Department of Health and Human Services’ Maternal, Infant, and Early Childhood Home Visiting Program and capitalize on the abilities of the Cooperative Extension System by providing focused education services to rural areas through enhanced outreach. HVRAP will address healthy family functioning and building the capacity of family and home-based childcare providers.

Specifically HVRAP will encourage grantees to implement programs that will demonstrate measurable outcomes in the following areas: 1) improved maternal, child, and family health; 2) prevention of child abuse, neglect or maltreatment; 3) improvement in school readiness; 4) improvement in financial capability; 5) reduced home health and safety risks; 6) reduced risk for family conflict; 7) improved capacity of family and home-based child care providers; and 8) improved coordination and referrals for other community resources and support.

HVRAP home visitors will provide service in high-poverty, rural (non-metro) counties, where at least 20 percent of the population have incomes below the Federal poverty threshold. The program will provide culturally and age appropriate in-home education to improve maternal, family and child health, focusing specifically on outcomes relevant to the unique needs of children, pregnant women, expectant fathers, and parents and caregivers of children in remote rural and tribal areas.

Click here for commentary on HVRAP from Secretary Vilsack. Full budget summary is available here, information on HVRAP can be found on page 95.

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Meeting Demand

By Courtney Rubin - US News & World Report

When she was a child living on a ranch in Montana and attending elementary school in a one-room schoolhouse with four other children, a career as a physician didn't occur to KayCee Gardner. She'd never needed one. For a long time, says Gardner, 31, "I didn't even know doctors existed." However, she says that she always "enjoyed doctoring our cows."

Gardner's plan as she went off to Montana State University was to become an engineer. But she soon got the feeling that the work would lack the humanitarian rewards she craved. Searching for a better fit, she shadowed an X-ray technician and later a doctor on a Northern Cheyenne reservation. Both experiences impressed upon her that it must be possible to prevent a good many health conditions by giving people better access to physicians.

Gardner graduated in 2012, did her residency at Montana Family Medicine in Billings, and is all set to begin practicing in Miles City – population 8,000 – this fall after she wraps up a rural medicine fellowship with a focus on high-risk obstetrics. That should help equip her for the huge range of tasks she expects to face – everything from putting tubes in tracheas to treating trauma patients and performing cesarean sections.

Read the full article.

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Mark Your Calendar

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

April 25-26: National Reduce Tobacco Use Conference - Washington, DC
April 26: Virginia Colorectal Cancer Roundtable - Fairfax
May 10-13: NRHA Annual Rural Health Conference - Minneapolis, MN
June 9: 2016 Health Care Conference - Richmond
July 13-15: Rural Quality & Clinical Conference - Oakland, CA
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO

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Resources

Opioid Webinar
Recording of the webinar on a community response to the opioid crisis, hosted by the Virginia Hospital & Healthcare Association.

Medicare Quality Reporting Programs Modules
Watch seven new MLN Connects videos on the Medicare Quality Reporting Programs, focusing on the requirements you need to meet in 2016.  For those who participated in the webinars held in February, the information in these modules mirrors the information shared on those calls:

Six Years of the Affordable Care Act
Six years ago, President Obama signed the Affordable Care Act into law. A February study from the Department of Health and Human Services found that 20 million people gained coverage that they wouldn’t have had without the ACA.

Drug Poisoning Mortality: United States, 1999 - 2014
Includes charts, graphs, and maps depicting drug poisoning mortality data by national, state, and county level for the years 1999-2014. 

State Telemedicine Gaps Analysis: Coverage and Reimbursement
A summary of telemedicine policy across the 50 states, with a specific focus on reimbursement standards and available coverage. Includes maps, data, and statistics using a grading scale for each state to allow for direct comparison.

State Telemedicine Gaps Analysis: Physician Practice Standards & Licensure
A summary of telemedicine policy and how it affects the use and availability of services for both patients and physicians across the 50 states. Includes maps, data, and statistics using a grading system for each state to allow for direct comparison.

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Funding Opportunities

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

Lowe's Charitable and Educational Foundation: Community Partners
The Lowe's Charitable and Educational Foundation is dedicated to enhancing the quality of life in the communities where Lowe's operates stores and distribution centers throughout the United States. The Foundation’s Community Partners grant program supports nonprofit organizations and local municipalities undertaking high-need projects such as building renovations and upgrades, grounds improvements, technology upgrades, and safety improvements. Most grants range from $10,000 to $25,000. The application deadline for the spring funding cycle is May 23, 2016; the fall funding cycle will be open from July 1 to August 26, 2016. 

Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths
Due May 21, 2016.
The Substance Abuse and Mental Health Services Administration (SAMHSA) will make up to 11 awards of $1 million dollars to governments of U.S. states and/or territories o reduce the number of prescription drug/opioid overdose-related deaths for the purchase of naloxone and training of first responders.

Medication Assisted Treatment - Prescription Drug and Opioid Addiction (MAT-PDOA)  
Due May 31, 2016. 
SAMHSA will also expand access to Medication-Assisted Treatment for opioid disuse with up to 11 awards of $1 million each.  Eligibility is limited to 28 states identified with having the highest rates of primary treatment admissions. (See Appendix V on page 45 of the program guidance for eligible states.)
 
Innovative Coordinated Access and Mobility Grants Program
Due May 31, 2016. 
Transportation is one of the biggest barriers to health care for rural residents. The goal of the competitive Rides to Wellness Demonstration Grants is to find and test promising, replicable solutions that foster local partnerships between health, transportation, home and community-based services to increase access to healthcare.  Eligible applicants are states and tribal organizations that can demonstrate collaboration between transportation, health care and human services sectors.

Healthiest Cities and Counties Challenge
The Healthiest Cities and Counties Challenge offers an opportunity for small and mid-sized U.S. cities and counties, as well as federally recognized tribes, to compete over the course of several years to develop practical, evidence-based strategies to improve measurable health outcomes and promote health and wellness, equity, and social interaction. The Challenge supports communities in their collaborative efforts to become healthier places to live, work, learn, play, and pray. The Challenge has two phases: Phase One includes the submittal of applications by cities, counties, and tribes and the subsequent selection of finalists for Phase Two. At the beginning of Phase Two, all finalists will receive a community seed grant of $10,000 to help move their programs forward. In addition, one grand prize and four runners up prizes will be awarded in each tier at the end of Phase Two. (Tier One includes communities with populations of 65,000 to 250,000 and Tier Two includes communities with populations of 250,001 to 600,000.)
The application deadline for Phase One is May 31, 2016.

American Psychiatric Association Foundation: Helping Hands Grant Program
The American Psychiatric Association Foundation is dedicated to advancing public understanding of mental illnesses. The Foundation’s Helping Hands Grant Program was established to encourage medical students to participate in community service activities, to raise awareness of mental illness and the importance of early recognition of illness, and to build medical students’ interest in psychiatry and working in underserved communities. The program provides grants of up to $5,000 to medical schools for mental health and substance use disorder projects that are created and managed by medical students, particularly in underserved minority communities. Funded projects can be conducted in partnership with community agencies or in conjunction with ongoing medical school outreach activities.
The application deadline is June 10, 2016. 
 

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