VRHA Weekly Update
In this Issue June 2, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available





Close the Gap!

VRHA encourages you to continue to support closing the coverage gap - and here's a new way to do it!

Several localities are making resolutions supporting closing the coverage gap for uninsured citizens.  Your community can do this as well!  Contact your local county board or town council members and encourage them to pass an official resolution in support of closing the gap.

Here's the resolution recently passed by the Town of Blacksburg.

If your locality is already considering a resolution, make sure you contact your elected officials to support their decision, such as this great letter submitted by LewisGale Hospital in support of Pulaski's pending resolution.

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Members in the News

By Travis Williams - Roanoke Times

Joshua Downing’s eyes lit up as he looked down at the human brain in his hand.

“It’s fun,” the Auburn Middle School student said. “Just being able to hold something that’s inside you right now.”

Joshua was one of 53 seventh- and eighth-grade students to take part in [VRHA member] Edward Via College of Osteopathic Medicine’s mini-med school held in the school’s cafeteria.

For more than an hour, the students rotated through the medical-student led stations, learning about topics such as sexually-transmitted diseases, drug abuse, depression and eating disorders. They also got to inspect a donated human brain, heart and liver, as well as practice CPR on a manikin.The experience was part of Auburn guidance counselor Susie Weaver’s annual program dedicated to providing each of her eighth-grade students with a preview of a potential career.

Read the full article.

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More Members in the News

NOTE: Dr. Byrd was the 2007 winner of VRHA's Charles Crowder, Jr. Award.

By Katie Demeria - NV Daily

Dr. Gregory Byrd was a core founding member of [VRHA member] Shenandoah County Free Clinic. After 18 years, he is leaving the position of board president, though he will continue to volunteer with the clinic as a physician.

Byrd was vital in creating the free clinic in the first place, Murphy said. He was one of a group created by Shenandoah Memorial Hospital that consisted of various community leaders to look at what needs were not being met in the county.

Read the full article.

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Virginia News

Too Many C's

By Callan Gray - WCYB

There are too many babies are being born by cesarean section, according to research by Consumer Reports.  The group analyzed more than 1,500 hospitals across 22 states on their ability to avoid doing c-sections on women having low risk deliveries. The data showed that more than half of those hospitals are doing c-sections on women who may not need them.

There were five hospitals in Southwest Virginia included in the report: Three Mountain States Health Alliance hospitals, Wellmont's Lonesome Pine Hospital and Wythe County Community Hospital.

Wellmont released a statement, which said in part; "the data from Consumer Reports represent an incomplete picture of Wellmont Health System's deliveries, as just one of our four birthing units was included."

Read the full article

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Hanger's Expansion Proposal

By Ben Paul - Healthcare for All Virginians

Senator Hanger's new proposal which would allow legislators to adopt a budget along with legislation about Medicaid expansion. The legislation would amend Virginia's Medicaid program to include the expansion population if: (1) Secretary Hazel advises the MIRC that all required reforms have been "confirmed"; and (2) the MIRC does not vote to delay or suspend expansion by a majority vote of the MIRC members (i.e. 6 of the 10 voting members.)  This proposed process is the opposite of current MIRC law, which requires 3 MIRC members from the House and 3 MIRC members from the Senate to endorse expansion.
The legislation adds a few additional reforms to the list adopted in the 2013 budget, but specifies that reform conditions can be met through planning or ongoing processes. (So there can no longer be objections that the reform conditions aren't met until fully completed and yielding actual savings).
The legislation also describes the "private option plan" for new coverage.  It incorporates much of the language in the "Marketplace Virginia" plan in the Senate's budget, but also adds a few new components.  It also calls for planning for a state-based health insurance exchange.
This is an important development that might help to end the current legislative gridlock, but there's still a long way to go.  We are doing additional research and analysis of the details of the proposed legislation.
Senate Hanger has been a strong and committed supporter of expansion.  As a member of Senate Finance; chair of Senate Finance HHR; budget conferee, and co-chair of the MIRC, he truly is in a special position to try to get this done.   We appreciate his support and efforts!

News clips on Senator Hanger's proposal:

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Close to Home

By the Harlan Daily

Health care is often viewed as an economic necessity in rural Kentucky. Current and historical data show that hospitals are as vital to communities like Harlan County for their economic activity as for the medical services they provide.

“When companies or businesses are considering expansion, they want to know what your health care situation is,” said Harlan County Judge-Executive Joe Grieshop, who has been involved in multiple industrial recruitment and business development efforts during his 16 years in office.

“It’s a subject that is always on their agenda because it’s something they need for their business, their employees and their families,” he added. “The hospital is an important asset to our community’s future economic development because its presence is a key factor in attracting any new business.”

According to the Kentucky Hospital Association, in 2012 (the most recent year for which complete data is available), Harlan ARH Hospital spent nearly $42.5 million on employee wages and salaries, and the purchase of supplies and services.

"These dollars have a ‘ripple effect’ as they move through the larger economy in the community,” Grieshop said. “These dollars support other businesses and jobs here.”

Read the full article.

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National News

Action Alert!

2 bills are currently going through Congress that need your support:

  • S. 2037, H.R. 3991
    Critical Access Hospital Relief Act of 2014 - Amends title XVIII (Medicare) of the Social Security Act to repeal the 96-hour physician certification requirement for inpatient critical access hospital services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital.
  • S. 1143, H.R. 2801
    Protecting Access to Rural Therapy Services (PARTS) Act –To amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient services.
Please contact your members of Congress and ask them to support these important bills.  Not sure who your members are?  Look them up!

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Survival of the Fittest

By Kathleen Belanger - Rural Assistance Center

Special Health Resources for Texas, with headquarters in Longview, Texas, has received a grant from HRSA to find women of color who are newly diagnosed with HIV, to help them obtain medical assistance during their illness and maintain their medical regimen.  The grant, called Survival of the Fittest, utilizes a multidisciplinary team approach including social workers, case managers, nurses, doctors, dentists and other specialists, as needed.  The case manager (or other significant member of the team) is available to be with the client when needed, even at telemedicine appointments. Social workers call the client at least once a week, and often twice a week, and this continuous though relatively inexpensive support leads to increased treatment adherence, fewer missed appointments, fewer hospital stays, and better physical and mental health.

The program is evaluated through stakeholder studies (surveys) at baseline, then at three, six, 12 and 18 months. It is also evaluated through the telling and analysis of “survival stories,” a kind of participatory action research that not only provides qualitative information about the challenges and resilience of the fastest growing HIV population, but also leads women to learn about themselves and, at times, rethink their lives.  And this may be the key to the program’s success.  The participants have people who call them, who care about them, and who want to know about them and listen to their stories.  This, in turn, causes the women to listen and reflect, and value their own lives.

Read the full article.

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The Cost of Serving the Poor

By Rich Cohen - Non Profit Quarterly

Rural America can’t seem to get a break. According to Valerie Bauerlein in the Wall Street Journal, rural hospitals have long been financially challenged, but now the Obama administration says that rural hospitals have been getting federal subsidies they weren’t supposed to have gotten and should therefore should be cut out of $2.1 billion in Medicare payments for “crucial access” hospitals.

Rural hospitals aren’t being hit just by the Obama administration. Anti-Obamacare states that have refused to expand Medicaid coverage often cover large swaths of rural America. Rural hospitals in those states won’t be benefitting from the Medicaid payments that would have covered uninsured patients had those states taken advantage of the federally subsidized expanded coverage offer.

As a result, rural hospitals, roughly about 2,000 in existence, are beginning to succumb to financial pressures. More than a dozen closed in 2013 and additional rural hospitals seem to be on their way to shutting down this year.

Read the full article.

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Rural Publications

Health Insurance Coverage of Low-Income Rural Children Increases and is More Continuous Following CHIP Implementation
Prior to the passage of the Children’s Health Insurance Program (CHIP), about one in four low-income rural and urban children (family income below 200% of the federal poverty level) were uninsured in a given month. Using data from the Medical Expenditure Panel Survey, this study found that in the years following CHIP’s implementation health insurance coverage and continuity increased among low-income children—particularly for those living in rural areas. By CHIP’s maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children (14% compared to 20%, respectively). Among those with health insurance, rural children were more likely than their urban counterparts to lose coverage pre-CHIP, and were less likely to lose it after CHIP was in place for five or more years. Whether low-income rural adults will see similar gains in coverage continuity under the Affordable Care Act may depend on whether states choose to participate in Medicaid expansions and what outreach strategies they use to enroll rural populations. 

Extent of Telehealth Use in Rural and Urban Hospitals
Using the 2013 HIMSS Analytics database, we analyze the extent of use of telehealth (aka telemedicine) and find that 34.0% of rural hospitals and 32.0% of urban hospitals had at least one telehealth application currently in use. Rural and urban hospitals did not differ significantly in overall telehealth implementation rates, however rural and urban hospitals did differ in the department where telehealth was implemented. In particular, rural hospitals were more likely than urban hospitals to have implemented telehealth in radiology departments and in emergency/trauma care. In contrast, urban hospitals were more likely than rural hospitals to have implemented telehealth in cardiology/stroke/heart attack programs, neurology, and obstetrics/gynecology/NICU/pediatrics. Follow-up research will verify the differences in types of telehealth implemented and investigate the low reported utilization rates, which may result from confusion of survey respondents about what constitutes telehealth. 

Integrated Care Management in Rural Communities (Working Paper & Policy Brief)
With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), the authors of this study review the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. We assessed four types of organizational models for delivering integrated care management. Each of these models has different strengths and drawbacks, weighing for and against implementation in rural areas. 

High Deductible Health Insurance Plans in Rural Areas (Working Paper & Policy Brief)
Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.  Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces. 

Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes
Examines patterns of diabetic preventive care use among adults with diabetes to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e. the presence/absence of a mental health diagnosis).
Key findings include: Rural residents with diabetes are generally less likely than their urban peers to use diabetic preventive services; Rural residents with diabetes and mental health diagnoses used some preventive services at about the same rates as urban people with diabetes, and at higher rates than rural diabetics without mental health diagnoses; Although rural residents with diabetes and mental health diagnoses used preventive care about as often as other groups studied, they had more diabetes complications than their rural peers without mental health diagnoses. 

Safety Net Clinics Serving the Elderly in Rural Areas: Rural Health Clinic Patients Compared to Federally Qualified Health Center Patients
Uses data extracted from 2009 Medicare outpatient provider claims to look at the location of clinics, the number of beneficiaries served, and the number of and cost per claim for each type of rural safety net clinic. We further examined characteristics of Medicare beneficiaries comparing their age, the health problems for which they sought care, and the distance they travelled to obtain care. Because Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) are similar in mission but may be different in practice, understanding their respective Medicare patient profiles is important. This findings brief is the third and final in a series on RHCs which draws on a large, national dataset that includes claims data on the approximately 90% of RHCs that billed Medicare in 2009. 

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Mark Your Calendar

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

June 11: SW VA Managed Care Provider Meeting - Abingdon
June 12: The  State Street Project: Health Across Borders - Bristol
June 16: Health on the Homefront: Addressing the Health Needs of Members of the U.S. Armed Forces, Veterans and Their Families - Hampton Roads
June 20-21: Dental Care Approaches for Adults with Disabilities - Lynchburg
June 26: Addressing Disaster Preparedness in Rural Communities - Richmond & videoconference
July 16-18: Rural Quality & Clinical Confernce - Atlanta, GA
September 30-October 1: Rural Health Clinic Conference - Kansas City, MO
October 1-3: Critical Access Hospital Conference - Kansas City, MO

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Profile of Rural Residential Care Facilities: A Chartbook
As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place. 

A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments. 

Cultural Competency Program for Oral Health Professionals (CCPOHP)
An e-learning program designed to better equip oral health professionals with the knowledge and skills to better serve diverse patient populations. 


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Funding Opportunities

Mary Reynolds Babcock Foundation
The Mary Reynolds Babcock Foundation assists people in the southeast United States to build just and caring communities that nurture people, spur enterprise, bridge differences, and foster fairness. The Foundation is dedicated to helping people and places to move out of poverty and achieve greater social and economic justice. Grants are provided to local, statewide, and regional nonprofits in Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia that work with people in low-wealth communities to shape their own destiny. Organizational summaries may be submitted throughout the year. 

Fred Adair-2014 Rural Scholarship
The rural scholarship was created to develop more counseling services in rural communities, which suffer disproportionately from a lack of mental health care. This scholarship is awarded to counseling students who commit to practicing in rural areas upon graduation. This scholarship provides $5,000 in financial support for a master’s-level counseling student in Virginia who has substantial experience with rural communities and commits to serving this underserved population for two years after graduation.
Deadline: June 30

Department of Agriculture
The Distance Learning and Telemedicine program provides funding for distance learning and telemedical equipment and related software in order to improve and increase quality educational and medical services in rural communities. The application deadline is July 7, 2014. 

Evidence-Based Tele-Emergency Network Grant Program 
The EB TNGP is intended to support implementation and evaluation of broad telehealth networks to deliver 24-hour Emergency Department (ED) consultation services via telehealth to rural providers without emergency care specialists.
Deadline: June 19, 2014

Voices for Healthy Kids
Deadline: Ongoing
Funding to support  lobbying activities related to a strategic issue advocacy campaign focused on fighting childhood obesity at the state, local and tribal level.

Benjamin Rose Institute on Aging Innovation in Caregiving Award
Deadline: June 30th, 2014 
Funding to support adults who, in the course of caring for an adult aged 60 or over in a private home or a residential setting, have come up with a technique that solves a care-giving challenge, or have found a new application for an existing device or technique that supports care-giving.

American Academy of Pediatrics: Community Access to Child Health Program
The Community Access to Child Health (CATCH) Program, a national initiative of the American Academy of Pediatrics, is designed to improve access to healthcare by supporting pediatricians that are involved in community-based efforts to enhance the health of children. CATCH Planning and Implementation Grants of $5,000 to $12,000 are awarded to pediatricians and fellowship trainees to develop or implement innovative initiatives that increase children's access to medical homes and available insurance programs. (Grants of up to $3,000 are awarded to pediatric residents addressing the same issues.) The application deadline is July 31, 2014. 

Department of Justice
The Keeping Kids in School and Out of Court program provides support to enhance collaboration and coordination among schools, mental and behavioral health specialists, law enforcement, and juvenile justice officials at the local level to ensure adults have the support, training, and a shared framework to help students succeed in school and prevent negative outcomes for youth and communities. The application deadline is July 21, 2014. 

Department of Health and Human Services
The Community Economic Development Healthy Food Financing Initiative Projects program supports community-based efforts to improve the economic and physical health of people in areas designated as food deserts. The application deadline is July 21, 2014.

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Virginia Rural Health Association
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