VRHA Weekly Update
In this Issue  August 18, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available






VRHA in the News 

By VRHA Executive Director Beth O'Connor - Roanoke Times

Michael Thompson’s “Thoughts on Medicaid reform” (July 24 commentary) outlined 10 items that need to be considered in the Medicaid expansion debate. Unfortunately, it had several flaws. I would like to address three in particular.

In item 2, Thompson states that health care might be available through a free clinic. The reality is that Virginia’s free clinics had to turn away more than 10,000 potential patients in 2013 due to limited resources. One even has a bi-weekly lottery for available appointments.

In item 8, he notes that many hospitals in our state have significant profits. This is correct – however, the “billions of dollars” of profit he mentions are not equally spread around the state. While specialty hospitals in urban areas operate significantly in the black, Virginia’s small rural hospitals do not.

In item 10, Thompson advocates for the expansion of Remote Area Medical. Aside from the fact that this — like the expansion of free clinics – would require significant funding, he has misunderstood the purpose of RAM. The “R” stands for “remote” — RAM was originally developed to provide health care to Third World countries.

Read the full editorial.

YOUR TURN!  Submit a letter to the editor of your local paper in support of Medicaid Expansion.  Click here for talking points.

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Members in the News

VRHA member Dr. Karen Rheuban, Senior Associate Dean for CME and External Affairs Director, University of Virginia Center for Telehealth was on Capitol Hill recently as part of the House Committee on Small Business.

The Subcommittee on Technology held a hearing titled, Telemedicine: A Prescription for Small Medical Practices?​  The purpose of the hearing was to examine  the use of telemedicine and its possibilities for small medical practices.  Dr. Rheuban provided testimony during the hearing.

Information provided during the hearing can be found here.

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More Members in the News

By Josette Keelor - NVDaily.com

At Medical Career Investigation at [VRHA member]Shenandoah Memorial Hospital in Woodstock and Camp MED II at [VRHA member] Warren Memorial Hospital in Front Royal, school children will gain a better idea of how hospitals work and learn that not all health care jobs require scrubs, sutures or a medical degree.

The Shenandoah County program for rising sixth through ninth graders has two sessions, this week and next, and the Warren County program this week for rising eighth through 12th graders is a follow-up to the 11th annual Camp MED I, which took place earlier this summer.

Read the full article.

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Virginia News

Expansion Paying Off

By the Free Lance-Star

Hard-pressed of states that have approved Medicaid expansion continue to gain from it. The Gallup-Healthways Well-Being Index this week revealed that, of the 10 states reporting the largest declines in the number of uninsured adults, all 10 were ones who have either opted for Medicaid expansion or established state-based marketplace exchanges.

In Arkansas, the percentage of uninsured adults fell from 22.5 percent in 2013 to 12.4 percent this year, a drop of 45 percent. In Kentucky, the rate went from 20.4 percent to 11.9, a 42 percent drop. In Delaware, the drop was from 10.5 percent to 3.3 percent, almost 70 percent.

Virginia? Don’t ask. We are paying for the political skullduggery and lack of empathy for the working poor that ensured that we would not accept the expansion, designed to help those who fall into the gap between the poverty line and the income level where Obamacare coverage begins. 

Read the full article and a related report on the funds being wasted by not expanding Medicaid from the Robert Wood Johnson Foundation.

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Senior Dental Care

By Ted Sherwin - GoDanRiver.com

It’s no secret today a healthy body starts with a healthy mouth.

That is abundantly clear when you look at the teeth and gums of many nursing home residents in Virginia, the vast majority of whom receive no dental care because Medicaid does not pay for it. As a result, many of these individuals develop infections and other conditions that must be treated in hospitals, at much greater expense to Virginia taxpayers. This is not just a problem in the Old Dominion, which has 29,000 nursing home residents, 60 percent of whom are on Medicaid. Dr. Sarah J. Dirks, a dentist who treats nursing home residents in San Antonio, told The New York Times in 2013 the lack of daily oral care in nursing facilities is “an epidemic that’s almost universally overlooked.”

There are three main reasons for this: lack of funding, insufficient awareness of the problem and ironically, the fact losing teeth is not necessarily an inevitable result of age. Let me explain.

Read the full editorial.

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Helping Hospitals

By Michael Martz - Richmond Times-Dispatch

Virginia’s influential hospital association has hired three former state legislators — one of them also a former member of Congress — as paid staff to reach out to elected officials and others to help community hospitals through perilous times.

The Virginia Hospital & Healthcare Association said Monday it had hired former Del. Dave Nutter, R-Christiansburg; former Sen. Mary Margaret Whipple, D-Arlington; and former U.S. Rep. Thelma Drake, a Republican and also previously a member of the House of Delegates and director of the Department of Rail and Public Transportation.

Virginia’s hospitals face “unprecedented levels of change and uncertainty. These leaders will help the association and its members navigate these difficult waters.”

Read the full article.

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National News

Policy Recommendations

By Joe Kimball - MinnPost

A report that says policy changes are needed to strengthen rural health care was released by Sen. Amy Klobuchar, who is vice-chair of the U.S. Congress Joint Economic Committee. The report, "Keeping Rural Communities Healthy," looks at the issue from a national perspective and notes that many rural hospitals provide high-quality care and are often less expensive than urban hospitals, but that access can be a problem.

The report says that "rural areas have only 54 specialists for every 100,000 residents, compared to 134 for every 100,000 in urban areas. There are also fewer dentists in rural areas."

Suggestions offered in the report:

  • Protect the Critical Access Hospital program.
  • Fund programs that attract doctors to rural areas.
  • Enhance training for rural health care practitioners in preventive services.
  • Expand Telehealth Resource Centers and the Telehealth Network Grant Program.
  • Improve transportation infrastructure.

The report concludes:"Although many rural hospitals receive high ratings for their level of care, not all rural residents are able to easily access their doctors. In addition, rural residents often face significant health challenges. Improving rural Americans’ access to affordable health care would improve their quality of life and bolster economic opportunity in rural areas."

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Rural People at City Hospitals

By Tim Marema - Daily Yonder

About 40% of the rural population “bypasses” rural hospitals to get their inpatient treatment at urban facilities, a report from the National Center for Health Statistics shows. Patients from rural America who were treated at rural hospitals tend to be older and on Medicare, the report says. And they tend to be patients who do not receive surgery or other procedures.

The patient load of rural hospitals is one factor in a growing crisis in rural healthcare, which has seen an increasing number of hospital closures.

Read the full article.


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By Sheri Porter - AAFP

Family physicians provide much of the primary care for patients who reside in America's rural towns and communities. And many of those rural family physicians work collaboratively with nonphysician health professionals such as nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives (CNMs) to ensure that patients get the care they need. Count Keith Davis, M.D., of Shoshone, Idaho, among them.

"I almost hate to say I'm a solo physician because I have such a good team of providers. It doesn't really feel like a solo practice; I can be gone from the practice to go to meetings or take a vacation and the practice is covered very well," said Davis.

Read the full article.

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Rural Poverty and Public Health

By Amber Canto, Laura E. Brown, and Steven C. Deller - Choices

The links between poverty and poor health outcomes are numerous, complex, and intertwined. Since Lyndon Johnson’s call for a “War on Poverty” in 1964 launching a new era of welfare legislation, defining and addressing poverty issues have been focal points for public policy discussions and social welfare organizations. While there is well-developed literature in urban food access and poverty, rural poverty issues have received notably less attention in both the academic research and policy arenas. This is significant since poverty rates are highest in the most urban and most rural areas of the United States. Additionally, high and persistent poverty disproportionately occurs in rural areas (Weber et al., 2005).

It is well understood by community development professionals that “place matters” in discussions of poverty, or in other words, the causes, consequences, and policy measures for addressing poverty may differ across the urban-rural continuum. If this is the case, we might then ask, “What does rural poverty look like?” Most quantitative literature defines poverty according to the official U.S. Census definition in which a family is considered poor if its annual pre-tax income (excluding non-cash benefits such as food stamps) is less than the federal poverty threshold. These thresholds vary according to household size, but have not changed substantially since the 1960s. Studies will often look at contextual or community issues affecting poverty since income is typically used as the measure for defining being poor. According to these studies, the persistent effects of poverty in rural areas may be rooted in rural households’ isolation from schools, services, social interactions, and labor-market resources. Local community dynamics affecting cross-class relations, social capital, and race may also have an effect on poverty in rural areas. Similarly, contextual research suggests that living in a rural area may increase one’s chances of being poor (Weber et al., 2005). It is important to note, however, that the current and most commonly used measure of poverty has been substantially critiqued in that it fails to adjust for changes in standards of living over time or geography, or for availability of public goods which may vary significantly between urban and rural areas.

Read the full article.

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Mark Your Calendar

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

August 19: Telemedicine in Rural Communities: An Innovative Approach to Delivering Healthcare - webinar
August 20: Quality Innovation Network QIO Kick-Off Call
August 21: REVIVE! Training event - Lebanon
September 30-October 1: Rural Health Clinic Conference - Kansas City, MO
October 1-3: Critical Access Hospital Conference - Kansas City, MO
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton​

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Community Paramedicine
This topic guide defines community paramedics, highlights models and existing examples of community paramedicine, explains how to start a community paramedic program, and outlines issues and challenges community paramedics’ face. 

Rural ICD-10
Rural ICD-10 is the place for rural health professionals to find useful information, insights, resources, and inspiration for transitioning to ICD-10.

Become a Rural Health Fellow
The goal of the Fellows program is to educate, develop and inspire a networked community of rural health leaders who will step forward to serve in key positions in the National Rural Health Association, affiliated rural health advocacy groups and local and state legislative bodies. The Rural Health Fellows meet in person three times throughout the year to undergo intensive leadership and advocacy training.  In addition, Fellows take part in monthly conference calls to supplement their training, receive updates on legislative and regulatory concerns that impact rural health, and participate in a mentorship program with current members of the NRHA Board of Trustees. Fellows should be committed to advocating on behalf of rural health and should be dedicated to the NRHA's mission.

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Funding Opportunities

W.K. Kellogg Foundation
Deadline: Ongoing
Funding to organizations that seek to build economic security for vulnerable children and their families through sustained income and asset accumulation.

Brownfields Area-Wide Planning Program
Application deadline: Sep 22, 2014
Funding for projects to facilitate community involvement in area-wide planning approaches to brownfields assessment, cleanup, and reuse.

Healthy Communities / Healthy America Fund
Application deadline: Sep 22, 2014
Awards grants to free clinics to implement the CDC's National Diabetes Prevention Program.

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