VRHA Weekly Update
In this Issue  February 13, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Winter newsletter available.  
Check out the article on VRHA - page 15!






VRHA representatives had the opportunity last week to visit Washington, DC as part of the National Rural Health Association's Rural Health Policy Institute.  The Virginia delegation visited the offices of Representatives Conolly, Goodlatte, Wittman, Scott, McEachin, Comstock, Griffith, Brat, and Garrett, as well as Senators Kaine and Warner.

Click here for a review of the requests made as part of the Policy Institute.

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Members in the News

By Tammy Childress - Bristol Herald Courier

[VRHA member] Russell County Medical Center has been ranked No. 1 in the commonwealth of Virginia for nurse communication, according to data released by the U.S. Centers for Medicare and Medicaid Services.

“We care for our patients like they’re our own family; we really want to make a difference in their lives,”  Greta Morrison, the chief nursing officer at Russell County Medical Center said. “And we believe that good communication is key in making that happen.”

The practice of treating patients like family has made an impression on patients, as indicated by their responses to standardized patient surveys. With a score of 90 percent for the survey measure, “patients who reported that their nurses ‘always’ communicated well,” Russell County exceeds the Virginia average of 79 percent and the national average of 80 percent.

Read the full article.

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More Members in the News

From the Augusta Free Press

[VRHA member] Rockbridge Area Health Center and the Central Shenandoah Health District announced a partnership that will bring Title X Family Planning services to the Health Center.

Suzanne Sheridan, executive director of RAHC notes that “this decision is well aligned with the current health care environment. We need to work together to provide cost-efficient, coordinated and comprehensive medical care to meet the health needs of our patients. Combining the health department’s years of family planning expertise with our well-established primary care, pediatric, dental and behavioral health services will enable patients to receive a broader range of quality services and will allow us to expand clinical services in the area.”

Read the full article.

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Virginia News

Catawba Hospital

By Carmen Forman - Roanoke Times

A year after a state budget proposal recommended closing Catawba Hospital, a new state budget proposes allocating additional funds for the psychiatric hospital to hire 10 new caregivers.

The House Appropriations Committee’s proposed budget earmarks more than $800,000 for new “direct care positions” at the 110-bed Roanoke County facility. The additional staffers would offset the increase in the number of patients, according to the budget item.

The budget also allocates more than $450,000 to add more caregivers at the Piedmont Geriatric Treatment Center, the other state geriatric treatment facility the state considered closing.

Read the full article.

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Military Medics and Corpsmen 

From the Office of the Governor

Governor McAuliffe today announced the first veteran hire facilitated by Virginia’s Military Medics and Corpsmen Program (MMAC). The Governor proposed the legislation for the program using the Department of Veterans Affairs’ Intermediate Care Technician (ICT) Program, as a model. MMAC, is a two-year pilot program which allows recently discharged veterans and transitioning medics and corpsmen to perform certain medical procedures under the supervision of a physician or podiatrist at major healthcare systems across the Commonwealth. 

The program is authorized by legislation and passed the Virginia General Assembly with tremendous support. It focuses on a solution that addresses healthcare staffing shortages and boosts veteran hiring. Army medics, Navy and Coast Guard corpsmen, and Air Force medical technicians receive extensive and valuable healthcare training while on active duty. When they transition to civilian life, their military healthcare training often does not translate into comparable certifications or licenses required for civilian healthcare jobs. Many medically trained veterans often struggle to find unemployment and cannot apply their skills in the civilian healthcare sector. 

Read the full press release.

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Merger Delay

By David McGee - Bristol Herald Courier

The Virginia Commissioner of Health postponed any decision on the proposed cooperative agreement between two local health systems until June. Commissioner Marissa Levine approved a request from applicants Mountain States Health Alliance and Wellmont Health System to defer action, much as they did last month in Tennessee. A decision was originally expected February 6.

The two regional systems want permission to combine facilities, employees and operations to form Ballad Health. The plan has received significant support from area governments, chambers of commerce and some businesses, but is opposed by the Federal Trade Commission staff and some insurance groups that claim it would reduce competition and could impact health care.

Read the full article.

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National News

Repeal for Rural

From NPR

Scott Simon speaks with Maggie Elehwany of the National Rural Health Association about a possible Obamacare repeal. She supports the law, but says the way it was implemented has hurt rural hospitals.

SCOTT SIMON, HOST: The House and Senate have taken the first steps to dismantle the Affordable Care Act. It's not clear whether lawmakers will have a replacement for the law before it's repealed. The Affordable Care Act has allowed millions of Americans to buy health insurance for the first time. But it has been controversial. We don't know the impact on hospitals. Recognizing that there's no one answer, how has the Affordable Care Act affected rural hospitals?

MAGGIE ELEHWANY: Well, let's talk about kind of the overview. So the goal of the ACA was to help the 37 million uninsured out there. And, yes, uninsurance rates have gone down dramatically or at historic lows. But I think a lot of things were unforeseen.

And the way some of the regulations were implemented are actually harming rural America and not fulfilling the ultimate goals of the ACA. And what I mean by that is half of those 37 million - the goal was to expand Medicaid and get those folks into a Medicaid program. We know that a lot of states have taken the Supreme Court up on its option of opting out of Medicaid. That has predominantly hurt rural America.

Read the full interview transcript and related article from Pacific Standard.

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New Model

By Andis Robeznieks - MedCity News

CMS announced that it “intends to provide” Pennsylvania with $25 million to help fund the implementation of the rural healthcare model. This model calls for participating hospitals to receive fixed, global budgets from participating payers, including Medicare, set in advance to cover the cost of all the inpatient and outpatients services they provide.
The stated purpose is to provide predictable funding to allow rural hospitals to “deliberately redesign the care they deliver.” The program started Jan. 12 and is scheduled to end Dec. 31, 2023. Pennsylvania has committed to creating $35 million in Medicare savings over the course of the program.
Also, the initiative is intended to be budget-neutral for Medicare, so the growth rate of rural Pennsylvania’s per-beneficiary Medicare expenditures must not exceed the national rate for rural Medicare spending. An agreement has also been set to keep all-payer spending growth to at or below 3.38 percent — a rate which matches the state’s compound annual growth from 1997 to 2015, according to a CMS fact sheet.

Read the full article.

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Visa Crackdown

Parija Kavilanz - CNN Money

At his pediatrics practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal sees up to 10 patients a day. He's known some of them since they were born. Others, he still treats after they've graduated from high school. Al Nofal's expertise is critical. He is one of just five full-time pediatric endocrinologists in a 150,000 square-mile area that covers both South and North Dakota.

Yet, Sanford Health may lose Al Nofal and several other doctors who are crucial to its health care network.  A Syrian citizen, Al Nofal is in Sioux Falls through a special workforce development program called the Conrad 30 visa waiver -- which basically waives the requirement that doctors who complete their residency on a J-1 exchange visitor visa must return to their country of origin for two years before applying for another American visa. The Conrad 30 waiver allows him to stay in the U.S. for a maximum of three years as long as he commits to practicing in an area where there is a doctor shortage.

After President Donald Trump issued a temporary immigration ban restricting people from seven Muslim-majority countries -- including Syria -- from entering the U.S., Al Nofal is unsure about his future in America. 

Read the full article.

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Rural Publications

2016 Rural Enrollment in Health Insurance Marketplaces, by State
In this brief, cumulative county-level enrollment in Health Insurance Marketplaces (HIMs) through March 2016 is presented for state HIMs operated as Federally Facilitated Marketplaces (FFMs) and for those operated as Federally Supported State-Based Marketplaces (FS-SBMs). Enrollment rates in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented. Results show that estimated enrollment rates varied considerably across the United States. In particular, estimated enrollment rates in non-metropolitan areas were substantially higher than in metropolitan areas in Hawaii, Illinois, Michigan, Montana, Maine, Nebraska, Wisconsin, and Wyoming. About half of all states, evenly distributed by Medicaid expansion status, had higher enrollment growth in non-metropolitan areas from 2015 to 2016, and in fact aggregated non-metropolitan growth was greater than metropolitan growth in both expansion categories. 

Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
Outcomes of care varied by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions, including acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease. Rural beneficiaries in the East South Central and West South Central Census Divisions had lower rates of being discharged to the community and higher rates of hospital readmission and emergency department use. Rural beneficiaries in New England, Middle Atlantic, West North Central, and Pacific Census Divisions had higher rates of being discharged to the community and lower rates of hospital readmission and emergency department use. Differences in rural beneficiaries’ home health outcomes appear to be related primarily to the region of the country where they live rather than other included community factors such as rurality of beneficiary residence (large, small, or isolated small rural areas), county-level economic status, and availability of local health resources. 

Changing Rural and Urban Enrollment in State Medicaid Programs
County-level data on Medicaid enrollment growth before and after ACA implementation were obtained and analyzed by rural and expansion status for 36 states—19 Medicaid expansion states and 17 nonexpansion states. As expected, average county-level Medicaid enrollment growth differed between expansion and nonexpansion states. In addition, metropolitan growth rates were higher than micropolitan and rural growth rates, although this difference was more evident for nonexpansion states than expansion states. At the state level, much variation was observed both in the urban/rural differential and across states in the same expansion category. Even in most nonexpansion states, there was some growth in Medicaid enrollment, likely due to the “woodwork effect”. Possible relationships exist between these geographic variations and pre-ACA Medicaid eligibility levels and the uptake of Health Insurance Marketplace coverage. 

Remote eye care screening for rural veterans with Technology-based Eye Care Services
By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Leading Causes of Death in Nonmetropolitan and Metropolitan Areas 
Across the United States, nonmetropolitan areas experienced higher age-adjusted death rates than metropolitan areas. The percentages of potentially excess deaths among persons aged <80 years from the five leading causes were higher in nonmetropolitan areas than in metropolitan areas. For example, approximately half of deaths from unintentional injury and chronic lower respiratory disease in nonmetropolitan areas were potentially excess deaths, compared with 39.2% and 30.9%, respectively, in metropolitan areas. Potentially excess deaths also differed among and within public health regions; within regions, nonmetropolitan areas tended to have higher percentages of potentially excess deaths than metropolitan areas.

Balancing safety and harm for older adults with dementia in rural emergency departments
HCPs in rural EDs working at the interface of hospital and community constantly attempt to balance promoting safety and avoiding harm for older adults with dementia. Participants perceived safety broadly, understanding that the consequences of the milieu were created through an interaction between physical, work and practice environments. These consequences related to the physical, cognitive and emotional wellbeing of older adults with dementia and their caregivers. Within the practice environment, participants identified a ‘rural advantage’ that was tied to their knowledge of community and the people with dementia and their caregivers who sought care in the participating EDs. However, familiarity can be a double-edged sword and to minimize potential harm healthcare professionals must seek input from caregivers regarding altered functional status, and policies to change triage to include gerontological knowledge and create elder-friendly rural ED environments are needed.

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Mark Your Calendar

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

February 15: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Abingdon
February 16: Opioid Epidemic in Rural America - Blacksburg
February 17: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Danville
February 18: REVIVE! Opioid Overdose Education - Marion
February 21: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS)  - Lynchburg
March 1: Livability in Action Regional Exchange - Christiansburg
​March 29-30: 2017 Population Health Summit - Charlottesville
April 2-4: MATRC Telehealth Summit - Leesburg

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Comparing the governor's and money committee amendments to the budget
The House Appropriations and Senate Finance committees released their proposed changes to the 2016-2018 budget (FYs '17 and '18) on Sunday, February 5, 2017. The governor released his back in December. Commonwealth Institute provides summary level assessment of key changes and other noteworthy information proposed by the money committees and the governor compared to the Chapter 780 version of the FY17 and FY18 budget -- the enacted budget -- which was passed in Spring 2016.

Rural HIV/AIDS Prevention and Treatment Toolkit
This new toolkit, developed by the NORC Walsh Center for Rural Health Analysis, provides information, strategies, and resources to help rural communities implement HIV/AIDS prevention and treatment programs. Browse program models and examples that span the HIV/AIDS care continuum. Learn how to implement, evaluate, and sustain a program in your community and disseminate program results.

Catalog of Value-based Initiatives for Rural Providers
Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI). Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Catalog includes descriptions of each demonstration and provides direct links to the corresponding agency web page.

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Funding Opportunities

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

Rita and Alex Hillman Foundation: Hillman Innovations in Care Program
The goal of the Hillman Innovations in Care Program, an initiative of the Rita and Alex Hillman Foundation, is to advance leading-edge, nursing-driven models of care that will improve the health and healthcare of vulnerable populations. The program seeks to support patient- and family-centered approaches that challenge conventional strategies, improve health outcomes, lower costs, and enhance the patient and family caregiver experience. The Foundation is particularly interested in the areas of maternal and child health, care of older adults, and chronic illness management. Two grants of up to $600,000 are awarded each year to nonprofit organizations, government agencies, and faith-based organizations throughout the country.
The application deadline is March 20, 2017.

Robert Wood Johnson Foundation Sports Award
Recognizing the ways in which sports influence healthy change in communities by helping children maintain a healthy weight, creating safe play environments, eliminating bullying, abuse and violence, and expanding opportunities for children living in poverty. 
Application deadline: April 6, 2017

Coordinating Efforts to Enhance Hospitals' Role in Population Health 
The Robert Wood Johnson Foundation is seeking proposals from organizations who can serve in the role of a coordinating office to enhance hospitals’ role in population health. The Foundation (RWJF) is committed to building a Culture of Health in America, which includes fostering cross-sector collaboration to improve population health, well-being, and equity. We recognize that hospitals can be key partners, especially in the communities in which they are located. Subsequently, RWJF will work in partnership with an external coordinating office to expand the impact and sharpen the strategy of the Foundation’s efforts to enhance hospitals’ role and investment in population health and the social determinants of health. The coordinating office will work with program officers at the Foundation and will maintain relationships with RWJF grantee organizations and other relevant organizations and leaders. The coordinating office is expected to embrace a collaborative learning approach that will help link grantees to one another and amplify what grantees and other organizations are accomplishing and learning about hospitals and health systems across the United States that are focused on total population health.
Deadline: March 1

Clinical Scholars 
This RWJF program is a three-year leadership program for clinically active health care providers and practitioners spanning a range of professions (see eligibility criteria for additional information). The program aims to provide providers with the opportunity to build and develop the unique skills they need to lead communities and organizations toward a Culture of Health. Strong applicants include a team that will bring a knowledge of and experience in the art and science of health care services, a unique perspective as providers in health and health care systems, and understand the special professional status and relationship with patients and communities.
Deadline: March 8

Black Lung Clinics Program (BLCP) & Black Lung Center of Excellence (BLCE)  
As many as 15 public, private, or state entities will receive funding to provide medical, outreach, educational, and benefits counseling services to active and inactive coal miners under the BLCP.  Under the BLCE, one entity will be awarded a cooperative agreement to help strengthen the operations of BLCP awardees through improved data collection and analysis. Both the BLCP and BLCE are three-year programs with an anticipated start date of July 1, 2017.
Deadline: March 6   

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