VRHA Weekly Update
In this Issue  October 10, 2016

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

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VRHA News

Poster Presentations

The following student posters have been accepted for presentation at the VRHA conference:
  • Southwest Virginia School-Based Co-Immunization Program Proposal to Reduce HPV-Related Cancer
  • Prevention Dispensers
  • Health Policy Collaborative
  • Social Determinants of Diabetes at a Rural Health Center

Come review the posters and support our future health professionals!  Click the conference logo to the right for full event details.
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VRHA Annual Conference
October 19 & 20
Abingdon, VA 

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Cultural Competency

The VRHA Conference will give you the opportunity to participate in an interactive workshop discussing what cultural competency and humility look like when they’re in the clinical setting. Family medicine physician and geriatrician, Dr. Ronna New tells stories from her training and clinical experiences to illustrate points made by Wendy Welch, PhD in Ethnography, on how rural areas and patients differ from urban teaching center expectations, and how that can be gently overcome with kindness and a sense of humor.

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Members in the News 

By Tammy Childress - HeraldCourier

[VRHA member] Southwest Virginia Community Health Systems, Inc. has earned The Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation by demonstrating continuous compliance with its nationally recognized standards. The Gold Seal of Approval is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care.

Read the full article.

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Virginia News

Medicaid Expansion

By James A. Lindsay Jr. - Washington Post

In Virginia, nearly 250,000 more residents have policies that provide real protection. It’s a life-changer for many. Yet hundreds of thousands of low-income Virginians are left out. While many people above the federal poverty level receive subsidies, those below that line who do not qualify for Medicaid must pay retail, a practical impossibility that leaves them without insurance and basic medical care, which can result in premature death or disability. They were supposed to be covered by Medicaid expansion, which the federal government would largely pay for. Our Republican-led General Assembly repeatedly blocked expansion. Virginia has lost more than $7 billion in federal funding. We’ve sacrificed thousands of health-care jobs and hundreds of millions in annual state budget savings (costs federal Medicaid would have paid).
 
The General Assembly should acknowledge the costs of our coverage gap and the benefits of closing it. The status quo has undermined Virginia’s ability to plan and fund vital community services and exacerbated its budget imbalance. It ignores the health-care needs of the uninsured and illogically denies the commonwealth the benefit of its residents’ federal taxes.
 
If there’s a better solution than Medicaid expansion, we need to hear it.

Read more on Medicaid Expansion from the Richmond Times-Dispatch.
 

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Drug Company Spending

From WDBJ7

In Virginia and in states across the country, drugmakers that produce opioids and allied advocacy groups are spending heavily as they work to influence state and federal policies. A joint investigation by The Associated Press and the Center for Public Integrity found that drug companies and allied groups spent more than $880 million nationwide between 2006 through 2015 on campaign contributions and lobbying expenses at the state and federal levels.

Pharmaceutical companies have been pushing legislation in statehouses across the country that require insurers to cover abuse-deterrent formulations of drugs, which can't be crushed into powder and snorted. A state commission in Virginia is currently studying the issue after a bill backed by Teva Pharmaceuticals was approved in 2015.

The makers of prescription painkillers have adopted a 50-state strategy that includes hundreds of lobbyists and millions in campaign contributions to help kill or weaken measures aimed at stemming the tide of prescription opioids, the drugs at the heart of a crisis that has cost 165,000 Americans their lives and pushed countless more to crippling addiction.

Read the full article.

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Opioid Crisis Solutions



Robert Devereaux is a family physician in this southwest corner of Virginia, where problems surrounding prescription opioid use far outstrip the capacity of psychiatrists and addiction specialists to treat them. When he found crushed fragments of painkiller pills inside the nose of an older patient with chronic back pain, the most Devereaux could do was refuse to prescribe more.

But some health professionals, as well as the federal government, think technology could offer a solution — by using video chat to connect patients in need with faraway physicians who know how to treat addiction.

Their telemedicine effort is part of a larger initiative to fight the opioid epidemic in hard-hit rural areas such as Appalachia. This summer, the U.S. Department of Agriculture directed $1.4 million to five pilot projects in southwest Virginia, Tennessee and Kentucky. One will be run by Carilion Clinic, the health system that operates Devereaux’s practice, along with other hospitals and medical practices in the region.

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National News

Bracing for MACRA

By Beth Jones Sanborn - Healthcare Finance

For small practices like those run by Jean Antonucci in Farmington, Maine, succeeding under new MACRA regulations will all boil down to the details. Unfortunately with MACRA, there are just so many she is just one of the many small practitioners dreading the rollout. That's not surprising given the 4,000-plus comments the Centers for Medicare and Medicaid Services received on the law.
 
"I don't gain anything positive from this that is not financial, and the financial gain is so tiny for the enormous complexity and reporting burden. It's not simple and it's not useful," Antonucci said.
 
Despite promises from CMS that the rule actually streamlines reporting and allows doctors more time with patients, many physicians say it is far too complicated. And with a third of her patients on Medicare, Antonucci doesn't believe she'll see much return on the investments she will have to make.
 
Antonucci is basically a one-woman show, handling both patients and all the administrative and reporting work for her practice. She has even outsourced billing, and gets help five hours a week when a medical assistant comes in to help with clerical work, patient follow-ups and care coordination tasks.

Read the full article.

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Medication-Assisted Treatment

By Nancy Shute - NPR

Only a fraction of the 4 million people thought to abuse prescription painkillers or heroin in the U.S. are getting medication-assisted treatment. There's been a big push to make it easier for doctors to prescribe buprenorphine, including new rules announced by the Obama administration in July that raised the number of patients a doctor can treat from 100 to 275. But this data suggests that those limits aren't the only barrier to getting treatment to more people.

Urban areas have typically been better equipped to provide treatment for opioid addiction, whether with methadone clinics or with buprenorphine, which people can take at home and doesn't require people a daily clinic visit. But many people struggling with opioid addiction live in smaller cities or rural areas where physicians have little experience with treating addiction to heroin and prescription opioids.

Just taking an online course on how to prescribe buprenorphine won't be enough for many providers, especially since many patients with opioid addiction also have other problems that need care. Medication-assisted treatment is supposed to include counseling, and that can be hard to find, especially in rural areas. 

Read the full article.

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Unsettled Country

By 

The archetype of quiet, small towns with a strong sense of community – where friendliness is abundant and “big city” stresses are few – often marks the popular imagery used to represent the state and its values.

But for many of those who live in Oklahoma’s rural areas, the reality does not match the trouble-free imagery. Outside of Oklahoma City and Tulsa and their suburbs, a disproportionate number of residents betray key signs of untreated mental-health problems and substance abuse, an Oklahoma Watch analysis of state data found.

Read the full article.

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Helping Rural America Catch Up

From the New York Times

Collection of opinion pieces, by rural experts, placed in "discussion" with one another concerning the challenges faced by rural America. Topics include, among other things, access to health resources, poverty, economic development, and technological infrastructure. 

Read the discussion.

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Mark Your Calendar

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

October 18: Rural Health Telecommunication Consortium Kick-Off Meeting - Abingdon
October 18-19:  Rural Health Coding & Billing Specialist Training  - Abingdon
October 19-20: VRHA Annual Conference - Abingdon
October 27: RHC Update Seminar - Compliance and Billing - Nashville, TN
February 5-8: Rural Healthcare Leadership Conference - Phoenix, AZ
February 7-9: 28th NHRA Rural Health Policy Institute​ - Washington, DC

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Resources

Virginia Grants Summit
Links to the Sept 15, 2016 Virginia Summit powerpoint presentations.

Rural HIT Workforce Curriculum Resources 
Here you will find a complete inventory of curriculum resources, including detailed course descriptions and training materials, developed by Federal Office of Rural Health Policy (FORHP) Rural Health Information Technology (HIT) Workforce Program grantees. 

Veterans Choice Program Education for Community Providers
The Veterans Choice Program was established so that eligible Veterans who are enrolled in the VA health system can receive care in their communities. Health care providers interested in participating in the Veterans Choice Program must establish either a Patient Centered Community Care (PC3) contract or a Choice Provider agreement with one of the U.S. Department of Veterans Affairs-approved contractors, Health Net Federal, or TriWest Healthcare Alliance. Both offer educational resources to help providers better understand the process.  
TriWest offers free live, interactive webinars for providers that cover the appointing and authorization process, secondary authorization requests, overall health care management process, billing and claims procedures, other health insurance, and medical documentation requirements. A live demo also explains how to use the secure Provider Portal to complete administrative tasks, such as uploading medical documentation and checking claims status.  To register for a TriWest webinar, click the link above.
 
Health Net
Provider orientation webinar covers an overview of Patient-Centered Community Care (PCCC) and the Veterans Choice Program, including covered regions, how to become a provider, and Veteran eligibility. Also, a presentation familiarizes providers with Health Net’s PCCC program, regions and attributes. The application promotes awareness of the Veteran experience: where they live; unique needs and challenges such as Veteran Integrated Service Network locations, socio-economic and health challenges; and VA resources.  

Kids’ Share 2016: Federal Expenditures on Children through 2015 and Future Projections
A look at federal money available to kids. The annual report, which examines federal spending and tax investments in children and families, paints a clear picture of the limited funding available to kids now–and in the future. While rising health care costs and broader eligibility will boost investments in children’s health, funding is down in areas like education, with a projected 24 percent decrease over the next ten years.

Network Board Development Guide
Designed to assist rural health networks in their efforts to establish, maintain, and improve the effectiveness of their board of directors. Offers suggestions in the areas of improving governance, member recruitment, meeting management, ethics, and legal requirements.

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Funding Opportunities

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

Robert Wood Johnson Foundation Health Policy Fellows
This program provides the nation’s most comprehensive learning experience at the nexus of health, science, and policy in Washington, D.C. It is an outstanding opportunity for exceptional midcareer health professionals and behavioral and social scientists with an interest in health and health care policy. Fellows participate in the policy process at the federal level and use that leadership experience to improve health, health care, and health policy.
Deadline: November 15

National Dairy Council: Fuel Up to Play 60
The Fuel Up to Play 60 program for K-12 schools nationwide provides grants of up to $4,000 to help implement one Healthy Eating Play and one Physical Activity Play from the 2016-17 edition of the Fuel Up to Play 60 Playbook. 
Deadline: November 2, 2016

Rural Health Network Development Program 
The Federal Office of Rural Health Policy (FORHP) will award approximately $27 million over a three-year project period to support the Program’s goal of assisting rural health care providers in acclimating to the evolving health care environment, including delivery system reform and the focus on population health and value based payment. Eligible networks applying to this program will demonstrate that they have positioned themselves for these changes and must be mature, integrated health care networks that have combined the functions of the entities participating in the network in order to: achieve efficiencies; expand access to, coordinate, and improve the quality of essential health care services; and strengthen the rural health care system as a whole.  Grantees under this program have used funds to address a variety of health care needs, including:  integrating behavioral and oral health into primary care, creating health information exchanges, creating value based health care systems, and implementing tele health programs.   
Deadline:  November 28

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