Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  November 3, 2013

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available





Cultural Competency:
The Rural Cultural Impact on Care



This conference session will discuss general cultural characteristics of rural residents that may be beneficial to healthcare providers as they work with patients and clients. Using Central Appalachia as a case study, Theresa Burriss of Radford University will stress the importance of understanding the historical context in which the community developed, as well as the political economies that shape the areas. She will present various stereotypes of rural residents that originated decades ago but still persist to this day. Related to this, she’ll outline the “model of poverty” versus the “model of internal colonization” that exists in many rural regions. While discussing typical values, inspired by Appalachian scholar Loyal Jones, and how those values influence rural residents’ thinking, believing, and being in society, the speaker will also talk about the diversity that often exists in rural areas. Moreover, she will address dialect, speech patterns, and colloquialisms, which can interfere with “outside” professionals’ ability to communicate effectively with rural residents.

Click the conference logo above for more details about the event.

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Deadline Approaching!

REMINDER: the deadline for submitting nominations for the VRHA awards is Friday, November 7th.  All Virginia Rural Health Association members and member organizations are invited to submit nominations for the 2014 Virginia Rural Health Association Awards.  Nominees are not required to be members of the association.  Commitment and service to the advancement of rural health in Virginia may be in the form of direct provision of health care services, governmental or educational advocacy, activities or research that improves the health of communities or populations.

Download the nomination form.  You can also read about past honorees

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Members in the News

[VRHA member] Virginia Oral Health Coalition is spearheading "Dental Care Approaches for Adults with Disabilities," with funding from the Virginia Board for People with Disabilities. The program will teach dentists the necessary techniques to treat patients with special needs and collect firsthand stories from individuals with developmental disabilities and their caregivers to advance policy changes that will increase dental coverage and care options for the nearly 9,000 Virginians with developmental disabilities. Coalition executive director Sarah Holland explains: "The goal is to capture stories that boldly illustrate the need to increase access to care, in order to lay the foundation for true change."

When you consider the unique physical and social needs of an individual with cerebral palsy or autism, it is clear to see that providing dental care to this population requires a little extra preparation. Adults with developmentally disabilities are more likely to suffer from gum disease than their typically-developing peers, and periodontal (gum) disease has been tied to higher risks of heart disease, diabetes and preterm birth. Regular, preventive dental care can help manage chronic diseases and improve overall health.

Read the full article.

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Virginia News

School Safety and Mental Health 

From the Office of the Governor

Governor Terry McAuliffe announced the Commonwealth has been awarded two five-year federal grants totaling nearly $13.3 million to improve mental health services for students and expand programs to make schools safer by reducing violence and disruptive behavior. 

A five-year “Project Aware” grant from the federal Substance Abuse and Mental Health Services Administration will provide more than $9.7 million between now and 2018 to support statewide training for teachers and other public school employees to respond to mental health issues in children and youth; and connect troubled students with appropriate community- and school-based services. 

The Project Aware grant also will fund pilot programs in three school divisions — Montgomery County, Pulaski County and Fairfax County — to create safer learning environments by improving communication and coordination between public schools, mental health service providers and other public and private agencies that focus on the well-being of children and young adults.  

Read the full press release.  

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Weaknesses in the System

By Alana Austin - NBC 29

Imbalanced funding and unequal services in Virginia's mental health system took top priority at the Mental Health Services Subcommittee meeting - and one state lawmaker is leading the crusade to fix the system.
Lawmakers and partners in the mental health system would like to raise the level of care for all Virginia communities. State Senator Creigh Deeds says it shouldn't matter where you come from or what your problem is; all Virginians deserve the same help.

Lawmakers and behavioral health leaders addressed weaknesses in the system at the meeting Thursday. Rural communities, with fewer dollars funneled into community-based care organizations, face more limitations.

Read the full article.

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No Margin For Error

From the Virginia Hospital & Healthcare Association

The Virginia Hospital & Healthcare Association (VHHA) today released a new report entitled
No Margin for Error: Virginia’s Rural Hospitals at a Crossroads.” The report documents the importance of Virginia’s 37 rural hospitals to their local communities and the challenges they face in today’s difficult operating and regulatory environment.

Speaking about the report, VHHA Board of Directors Chairman, John L. Fitzgerald, CEO of Inova Fair Oaks Hospital, said “Rural hospitals are the lifeblood of much of Virginia. They provide emergency medical care to those in need and preventative care that sustains communities. They also employ tens of thousands of Virginians and drive local economies. Unfortunately, by practically any measure, Virginia’s rural hospitals are under tremendous stress. The bottom line is that half of these hospitals are operating in the red, and some of them have been doing so for years. Our goal with this report is to highlight the unique challenges facing Virginia’s rural hospitals because even the slightest policy change can have dramatic effects on these hospitals and their services.”

Key points outlined in the report include:

  • In 82 percent of rural counties, health care is among the top five largest employers;
  • Virginia’s rural hospitals are projected to undergo federal reimbursement and funding cuts of $183 million in fiscal years 2015 and 2016 alone;
  • In 2012, seven of Virginia’s 37 rural hospitals had a negative net worth;
  • During the same period, 20 rural hospitals had negative operating margins;
  • Age-adjusted disease rates are notably higher in rural Virginia; and
  • Nearly 80 percent of patients at rural hospitals are either uninsured or have publicly-funded healthcare benefits.

Read the full press release and report.

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National News

Action Alert!

VRHA is joining NRHA in raising awareness on the plight of rural hospitals in America:

  • 26 rural hospitals closures in the USA since 2013.
  • More closures in 19 months than total between 2003 and 2012 combined.
  • 283 more rural hospitals are vulnerable to closure.

We are asking you to send a strong message to Congress to:

  • Stop the bleeding
  • Provide regulatory relief
  • Build bridge to the future  
Click here for detailed information and contacts for Virginia's members of Congress.  Not sure who your member is?  Check here.  Contact them today!

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New Rural Model

By Bob Herman - Modern Healthcare

When Stewart-Webster Hospital in Richland, Ga., closed its doors early last year, anxiety spread rapidly throughout the rural town of 1,500 residents.  The critical-access hospital—one of the town's largest employers that had been around for more than six decades—could no longer overcome the financial problems that many rural facilities face: high unemployment in the community, high rates of uninsured and underinsured patients, and declining reimbursements from government payers.“It was really a shock,” said Adolph McLendon, 75, the mayor of Richland who has gotten medical care at Stewart-Webster. Now many patients head 35 miles northwest to Columbus, Ga., if they need emergency or inpatient healthcare services.

For people in rural areas, a closed hospital means they have to travel farther, sometimes hours, for care. And that could mean life or death in situations such as cardiac arrest, car accidents, workplace injuries and other emergencies. Experts believe the free-standing ED approach must be part of a broader solution that mixes emergency care with beefed-up primary and preventive care, and that may require government support. But Georgia—where Republican elected officials have rejected expanding Medicaid, which hospital leaders say would help the finances of rural facilities—has proposed a regulatory change that some observers think could help rural hospitals across the country. In March, Gov. Nathan Deal said financially struggling rural hospitals can offer fewer inpatient services and still keep their hospital licenses. In essence, they can convert into free-standing emergency departments that stabilize and transfer patients to bigger hospitals. Under Deal's proposal, these rural facilities also could offer other basic services such as labor and delivery.

Read the full article.

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Treating Diabetes

By Candi Helseth - Daily Yonder

Carol B. has lost more than 100 pounds and cut her blood sugar averages in half since being diagnosed with Type 2 diabetes. But, she says, her disease is almost impossible to effectively control, so she is grateful for the professional assistance she receives from Heartland Rural Health Network (HRHN) in Avon, Florida.

HRHN Executive Director Kelly Johnson says their diabetes program helps bridge the gaps in a region where there are long distances between healthcare facilities, no public transportation and large populations of elderly, low-income residents that often have no personal transportation. While there is little data establishing reasons for the higher diabetes rates among rural populations, the situation Johnson cites is common in many rural areas and negatively affects patient access.
Community Health Workers (CHWs) who live in communities where they work are HRHN’s key link between clients and providers. CHWs see patients in their home to assess and assist them with home management practices, and confer regularly with providers about the patients.

Read the full article.


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Rural Expansion

By Stephanie Stephens - Medical Press

A new study in Health Services Research reveals that expanding Medicaid to cover more adults boosts health care access and use in rural populations.  Most previous studies have focused on urban populations, but more than 7 million uninsured people live in rural settings, the authors said, and the two health care profiles differ.

The nine study authors were all interested in what happens to use of health care services when public health insurance is expanded. "In particular, we find large increases in outpatient visits, no evidence of a change in ED visits, and a large increase in inpatient visits," wrote the authors. "We also estimate that public health insurance leads to increases in preventive care but no change in behavioral health care visits". Their estimates in this study were largely consistent with previous research, but also recognized potentially important differences.

Read the full article.

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Mark Your Calendar

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

November 5: Transitioning to ICD-10 - webinar
November 14: Virginia Oral Health Summit - Richmond
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton



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National Healthcare Quality & Disparities Reports
Select a State from the map or the drop-down list to view the state snapshots and explore the quality of your State's health care or compare it with national rates or data from best-performing States.

Health Insurance Outreach and Enrollment Models and Innovations 
These stories feature model programs and successful rural projects that can serve as a source of ideas and provide lessons others have learned. 

National Diabetes Month
Resources to encourage people with diabetes to have a comprehensive dilated eye exam at least once a year to detect diabetic eye disease in its early, treatable stages. 

Rural Health Disparities 
Topic guide to learn about the causes of these disparities and for rural/urban comparisons of health status, mortality rates, and life expectancy.

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Funding Opportunities

Benefits Enrollment Centers
National Council on Aging Center for Benefits Access is seeking nonprofit or public agencies to be part of our next cohort of Benefits Enrollment Centers (BEC). BECs use person-centered strategies in a coordinated, community-wide approach to find and enroll Medicare beneficiaries into available benefits. Organizations eligible to apply for BEC grants include state or community-based nonprofit organizations, government agencies, faith-based organizations, and coalitions addressing the needs of older adults and younger adults with disabilities. Organizations that have been funded in the past as BECs are not eligible for this award. Successful applicants will receive up to $100,000 over 15 months to enroll Medicare beneficiaries in core benefits. Letters of intent are due November 21, 2014. The deadline for full proposals is December 12, 2014. If you have any questions during that time, please contact

Accountable Care Organization Investment Model
Application deadline: Dec 1, 2014
Offers pre-paid shared savings to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to assume greater levels of financial risk, which will improve care for beneficiaries and generate Medicare savings.

Transforming Clinical Practice Initiative - Practice Transformation Network (PTN)
Letter of Intent (Optional): Nov 20, 2014
Application deadline: Jan 6, 2015
Awards funding to group practices, healthcare systems, and others that join together to provide clinician practices with quality improvement expertise, best practices, coaching and assistance. The aim of these networks is to help clinicians move from volume-driven systems to value-based, patient-centered, and coordinated healthcare services.

Community College Grant Initiative
Grants of up to $5,000 will be available to 100 public community colleges across the country to support their efforts to advocate for, adopt, and implement a 100% smoke-free or 100% tobacco-free policy. 
Deadline for applications: November 13, 2014 at 6:00 pm (ET).

Agricultural Safety and Health Council of America: Safety Grants Program
The ASHCA Safety Grants Program supports agricultural safety and health interventions in order to facilitate the application of evidence-based safety and health strategies to protect agricultural workers.

The Coca-Cola Foundation
The Coca-Cola Company and its global philanthropic arm, The Coca-Cola Foundation, partner with nonprofit organizations worldwide that address community needs and priorities in a meaningful way. Support is provided for programs that focus on one of the following four categories: Water Stewardship promotes access to clean water and sanitation, watershed protection in water-stressed regions, utilization of water, and water conservation. Healthy and Active Lifestyles supports physical activity and nutritional education programs, programs that motivate behavior modification, and programs that encourage lifestyle and behavioral changes. Community Recycling addresses litter abatement efforts, recovery and reuse, community recycling awareness, and research and innovation. Education focuses on scholarships, school dropout prevention, access to education programs, and other education initiatives. Online applications for grants or sponsorships may be submitted throughout the year.

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