VRHA Weekly Update
In this Issue October 23, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Fall Newsletter




Special Guest!

VRHA is pleased to announce that Kelly Thomasson, Secretary of the Commonwealth will be addressing the Virginia Rural Providers Conference this week!  Secretary Thomasson is one of Governor McAuliffe’s cabinet members working with the Commission on Diversity, Equity and Inclusion and will be discussing how diversity is essential to the health of our rural communities.

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Rx Abuse Forums

This weekend is the last opportunity to participate in the Prescription Drug Abuse Forums this fall. These FREE CME events provide health care providers with knowledge and skills to apply in clinical practice regarding prescribing controlled substances.

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Members in the News

By Dominick Mastrangelo - Roanoke Times

The Radford University Waldron College of Healthand Human Services has been awarded a four-year, $1.9 million mental and behavioral health education and training grant by the U.S. Health Resources and Services Administration. The grant money will underwrite the work of graduate students at the school who will provide care to real-world patients who have substance use issues in the New River Valley.

“It’s a significant problem not just in our area but across the country,” said Project Director and Associate Professor of Nursing Victoria Bierman [a VRHA member]. “Our whole goal is to end up providing a certificate for treatment therapy for our students. We can eventually offer this to other providers.”.

Read the full article.

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Virginia News


From NBC29

U.S. Sen. Tim Kaine (D-VA) introduced the Medicare-X Choice Act in the Senate Tuesday with Sen. Michael Bennett (D-CO). The plan would build on the existing Medicare framework, but would focus on increasing competition in rural areas to give people access to a public, affordable plan. 

Kaine's proposal follows President Donald Trump's announcement last week that he will be ending cost-sharing reduction payments, which could drive premiums up and lead to fewer insurers in the marketplace. Kaine says people in rural areas are already faced with limited choices for healthcare and often only one high-cost option.

"It would apply to a significant number of counties in Virginia and the United States because there will be 1,500 in 2018 that will only have one or fewer insurance companies offering policies, and that is where we will roll this Medicare-X out first," Kaine said.

If passed, Medicare-X would become available to counties with a shortage of healthcare providers in 2020.

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Going Digital

By Eric Wicklund - mHealthIntelligence

A mobile health service started more than 30 years ago out of the back of a Volkswagen is using telehealth, mHealth devices and even drones to improve healthcare access and outcomes in one of the most underserved regions of America.
The Health Wagon visits dozens of sites in southwest Virginia, targeting a region known for its rugged terrain, insular communities, high chronic disease, opioid abuse and suicide rates and limited access to healthcare and insurance.
“We’re just in a very poor resource area,” says Teresa Gardner Tyson, DNP, FNP-BC, FAANP, executive director of the Wise, Va.-based nonprofit.
But with a going digital health platform, the Health Wagon is giving Appalachia millions of dollars of healthcare each year and inspiring healthcare providers to add mobile outreach to their calendars.

Read the full article.

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Close to Home

By Katie Zezima - Washington Post

The nation’s opioid epidemic has unleashed a secondary outbreak: the rampant spread of hepatitis C.
New cases of the liver disease have nearly tripled nationwide in just a few years, driven largely by the use of needles among drug users in their 20s and 30s, spawning a new generation of hepatitis C patients. Because a treatment that cures the disease costs tens of thousands of dollars, is limited by insurance and Medicaid, and is mostly unavailable to people who are still using illicit drugs, there probably will be financial and public health ramifications for decades to come.
Here in West Virginia, which has the nation’s highest rates of overdose deaths and new hepatitis C and hepatitis B infections, public-health officials are attempting to identify as many new hepatitis carriers as possible — and are girding for decades of repercussions.

Read the full article.

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National News

Falling Short for Rural

By Maggie Elehwany - National Rural Health Association

Allowing the recent Executive Order signed by President Trump (which would remove insurance subsidies) to remain would likely mean insurance companies will pull out of rural markets entirely, clearly harming rural patients. Additionally, removing the subsidies would likely further exacerbate the rural hospital closure crisis. (Uninsured individuals still get sick and seek care in the emergency room, causing care to be subsidized by small, financially vulnerable hospitals. Bad debt is already up 50 percent since ACA has gone into law, forcing rural hospitals to close across the nation.) However, Alexander-Murray agreement misses an opportunity to truly address the great faults in the ACA rural marketplace.

NRHA as long advanced reform that would prevent insurance providers from withdrawing from rural markets. Despite record profit levels, insurance companies are permitted to cherry pick profitable markets for participation and are currently not obliged to provide service to markets with less advantageous risk pools. True, rural America may not reap huge profits for the insurance companies. (The demographic realities of the rural population make the market less profitable, and thus less desirable for an insurance company with no incentive to take on populations that are per capita older, poorer and sicker.) However, many insurers still report record profits - - and much of those profits come at the taxpayers’ expense. Many for-profit insurance companies are finding tax-payer subsidized Medicare Advantage and Medicaid-Managed Care contracts extremely beneficial to their profit margins. According to a June 2017 article in CNN Money, Medicare Advantage underwriting profitability “soared by 279 percent.”

Read the full article.

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Suicide and the Rural ER

By Edwin Leap - Daily Yonder

Rural patients struggling with mental-health issues often use the emergency room as their first point of contact with the medical system. But the next step in treatment is uncertain -- or nonexistent -- for patients without deep pockets.

I saw Jake in the emergency department of Tiny Memorial Hospital—both names have been changed for privacy—at 3 a.m. a few months ago. He was a spitting, screaming, muscular mess of rage. A local deputy brought him in handcuffs after his family called 911. He had been at his mother’s home, banging his head on the wall and talking about suicide. He was drunk and cycling between rage and sobs. His young wife had left and taken their 2-year-old boy with her. Everything in Jake’s life was spiraling out of control. The cause of the split was not forthcoming from anyone.

When he got to the hospital, I was busy with standard ER problems. Patients with chest pain and trouble breathing, a newborn with a fever and a diabetic patient with a seizure from low blood sugar. This is life in the wee hours of the ER. I was the only doctor on duty in the whole hospital; there was simply no time for the deep exploration of anyone’s emotional issues. Besides, Jake was too angry to talk. I ordered some lab tests and went back to moving patients through the department, knowing I could circle back.

Read the full article.

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MIPS Exemption Harm

By Lynn Barr - The Hill

The Center for Medicare and Medicaid Services’s (CMS) proposed rule to exempt two-thirds of the nation’s clinicians from the Medicare Incentive Payment System (MIPS) will do more harm than good. However, the difficulties to comply with quality reporting measures and the resulting burden on providers are significant.

As much as possible, we need to give physicians less paper and computer work and more time with their patients. However, excluding most of the country’s clinicians from CMS Quality Payment Program’s Merit-based Incentive Payment System (MIPS) will penalize clinicians, result in direct patient harm, and disable the infrastructure of electronic health records (EHRs) that has been subsidized with $37 billion taxpayer dollars.

Rural clinicians are exempt from quality reporting, and according to the federal government, have provided lower quality care. The National Rural Accountable Care Consortium has direct experience in rural quality reporting. Formed in 2013 by rural providers to create the first national rural Accountable Care Organization (ACO), the 501 non-profit organization represents 23 rural ACOs and more than 10,000 clinicians whose small and rural practices have fewer than 10 clinicians each, exactly the profile of practices proposed to be excluded from quality reporting. 

Read the full editorial.

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Underground Economy

By Michael S. Williamson - Washington Post

For the people of the hollow, opportunity begins where the road ends, and that was where they now went, driving onto a dirt path that vanished into forest. It was here that they came at the end of the month, when the disability checks were long gone, and the next were still days away, and the only option left was also one of the worst.

And where they were going was deep into the underground American economy, where researchers know some people receiving disability benefits are forced to work illegally after the checks are spent — because they can’t hold a regular job, because no one will hire them, because disability payments on average amount to less than minimum wage, sometimes much less, and because it’s hard to live on so little.

The underground economy has long been a part of rural America, but it has become vital in counties such as this one, deprived of the once-dominant coal industry and redefined by a decades-long swell in the nation’s disability rolls that, in its aftermath, has left more than 1 in 5 working-age residents in Logan County on Social Security Disability Insurance, which serves disabled workers, or Supplemental Security Income for the disabled poor.

Read the full article.

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Mark Your Calendar

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

October 24 & 25: Rural Health Documentation & Coding Bootcamp  - South Boston, VA
October 25 & 26: Virginia Rural Providers Conference - South Boston, VA
October 28: Rx Abuse Forum - Fishersville
October 29: Rx Abuse Forum - Lynchburg
November 2: 2017 Virginia Oral Health Summit - Richmond
November 2: APA Mental Health Disparities Program- Mental Health in Appalachia -Wise
November 12 & 13: Virginia Telehealth Network Summit - Richmond
November 15: Synthetic Narcotic & Opioid Abuse Prevention Summit - Abingdon

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Virginia Charity Care
What is the true value of charity care in Virginia?  Virginia Health Information seeks to provide answers with this infographic.

Rural Hospice and Palliative Care
This guide has been updated to include new information and frequently asked questions including challenges faced by the hospice and palliative care workforce and how rural providers compare on quality of care and patient satisfaction measures. Also links to resources and funding related to hospice and palliative care.

Model Program: Health Extension Rural Offices (HEROs)
The University of New Mexico Health Sciences Center created Health Extension Rural Offices (HEROs) whose agents link people in rural communities to local health and social services. 

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Funding Opportunities

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

MENTOR Network Charitable Foundation: Community Partners
The MENTOR Network Charitable Foundation works to build on The Network’s innovative approach to human services by seeking new solutions and creative ideas for enhancing the lives of people with intellectual and developmental disabilities, individuals with brain and spinal cord injuries, and youth at-risk facing emotional, behavioral, and other challenges. The Foundation's Community Partners program supports nonprofit organizations throughout the U.S. that are acting as change agents within human services by delivering innovative care or developing new ideas and models for doing so. The program accepts grant requests ranging from $2,500 to $5,000. Requests are reviewed quarterly.
Deadline for 2017 is November 15. 

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