Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  January 11, 2016

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


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The Virginia Health Opportunity Index is here!

 

 

 

VRHA News

Advocate This Month!

VRHA is partnering with Healthcare for All Virginians to send a clear message to the General Assembly about the need to close the coverage gap.  Here's how you can help:

1) Contact the General Assembly members that serve your area.  Tell them that the Affordable Care Act should be fully implemented to stop wasting taxpayer dollar and keep our rural communities physically and economically healthy.  Click here and here for additional talking points.

2) Write a Letter to the Editor or Op Ed for your local paper informing your community about the need to close the coverage gap by fully implementing the Affordable Care Act and thereby protecting the working poor and the rural economy.  Contact VRHA if you would like assistance in writing your letter, a great example can be found here.

3) Join VRHA as part of the Healthcare for All Virginians Coalition on January 27th in Richmond to urge our lawmakers to close the coverage gap in Virginia. Click here for more information.
NOTE: this event is FREE!

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Advocate Next Month!

VRHA will be taking part in the National Rural Health Assocation's Rural Health Policy Institute February 2-4 in Washington, DC.  Learn firsthand about the development and implementation of health care policy at the federal level and be part of the Virginia delegation visiting our elected officials.  VRHA staff will be working to set up appointments with Virginia's members of Congress for this event - JOIN US!

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Rural ACOs

Rural Health Clinics, Federally Qualified Health Clinics and Critical Access Hospitals  play a key role in the sustainability of Virginia’s rural health systems and are eligible to receive services through the Transforming Clinical Practice Initiative (TCPI) funding.  The support, training and programs provided will allow RHC’s, FQHC’s and CAH’s  to establish a value-based infrastructure at no cost. 

VRHA is teaming up with the National Rural Accountable Care Consortium to present:
Transforming Clinical Practice Initiative 
This free webinar will outline the tools and resources provided through the program and demonstrate the value they bring to RHC’s, FQHC’s and CAH’s.

So save the date for noon on January 27th and learn all about it!

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Virginia News

Medicaid Coverage Benefits

From the Georgetown University Health Policy Institute 

Virginia is one of the 20 states that has elected not to accept federal funding under the ACA to extend Medicaid coverage to parents and other low-income adults. Consequently, parents in Virginia are not eligible for Medicaid or premium tax credits if their incomes exceed approximately 45 percent of the poverty line (45 percent of poverty is $9,041 in annual income for a family of three in 2015) but remain below 100 percent of the poverty line ($20,090 in annual income for a family of three). As a result, there are nearly 230,000 Virginians (including childless adults) who fall into this coverage gap and as many as 400,000 adults excluded from Medicaid coverage due to Virginia’s refusal to accept the federal funds.

Key findings from this paper:

  1. Virginia’s General Assembly has chosen not to use federal funds available under the Affordable Care Act (ACA) for extending Medicaid coverage. Virginia’s Governor continues to support use of Virginia’s share of federal money to cover as many as 400,000 uninsured adults.
  2. Virginia has large numbers of uninsured children and parents. Almost one third (29 percent) of people potentially eligible for coverage should Virginia close the gap are parents with dependent children residing in their home. Providing health coverage to Virginia’s parents would reduce children’s uninsurance rate and enhance families’ financial security. Experience from other states shows that an extremely effective way to reduce the uninsured rate for children is to extend coverage to parents so the entire family can get covered.
  3. Of those parents that could benefit from closing the coverage gap, over two-thirds (68 percent) are employed. Over half of all uninsured parents (54 percent) work in restaurants, retail, construction, or medical occupations.

Read the full report and related article from Virginia Public News Service.

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Hospital Financial Challenges

From Alexandria News

Newly released figures from Virginia Health Information, the agency that gathers and reports health care data in the Commonwealth, underscore the fact that many local hospitals across the state continue to struggle financially. The numbers show that roughly 25% of Virginia’s acute care hospitals, and nearly 42% of rural hospitals, operated in the red during calendar year 2014. That continues a pattern consistently reflected in VHI annual data.

While the number of hospitals with negative operating margins can fluctuate from year-to-year, the ongoing trend of numerous hospitals operating in the red has alarming implications for access to health care, and Virginia’s economy. Financial pressure can also impede a hospital’s ability to make facility and equipment upgrades so patients have access to state-of-the-art treatment. It is commonly accepted in the industry that achieving a 4% operating margin is the minimum threshold necessary for hospitals to maintain fiscal stability and provide for capital expenditures. Based on VHI’s 2014 data, 18 of 31 rural hospitals fell below that mark. Statewide, 40 of 89 hospitals were in that category, which includes some with negative margins and others with modestly positive margins.

Read the full article and related stories from the Washington Post and Inside NOVA.

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Legislative Update

Recently introduced legislation which could impact health and healthcare in rural Virginia:

HB 193: Certificates of Public Need
HB 278: Prescription of opioids and benzodiazepines; urine drug screening
HB 255: Health insurance; coverage for mental health and substance abuse disorders
SB 265: Nurse Licensure Compact; current compact replaced with a revised version
SB 264: Nurse practitioners; practicing outside of a patient care team
HB 310: Mobile dental clinics; exemption from registration requirements
HB 311: Emergency medical services providers; interstate agreements
HB 312: VDH; increase sharing of electronic health records, report
HB 313: Immunizations; adds type of health professonals who may administer
HB 319: Volunteer health care providers; agreements with Department of Health
HB 330: Clinical nurse specialists; Board of Nursing may register applicant
HB 338: Affordable Care Act; use of resources to enforce
HB 348: Certificate of public need; exception for certain medical care equipment and services
HB 349: Certificate of public need; removes requirements for certain medical care facilities
HB 350: Certificate of public need; changes to Medical Care Facilities COPN
HB 354: Lyme disease; prevention pilot program

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National News

Help NRHA Halt Rural Hospital Closures

By Alan Morgan - National Rural Health Association

Less than a week into 2016, and we already have our first rural hospital closure of the New Year. Saint Mary’s Hospital in Streator, Ill., a 94-bed rural hospital, closed inpatient and emergency room care on Jan. 4. 

The National Rural Health Association urges policy makers to focus on this growing health crisis, which threatens basic access to health care for rural Americans.  NRHA projects the potential for more than 200 additional rural hospitals to close in the near future without local, state and federal intervention.

Read the full article and join VRHA at the NRHA Rural Health Policy Institute!

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Price Transparency

By 

Millersburg, Ohio is a 700-mile drive from Unionville, Missouri, so it’s an unlikely place for a Unionville resident to schedule a medical procedure. That is, unless they’re paying cash. It was worth it for Truman, a Mennonite farmer who lives just outside of Unionville. "The best price I could get around here, I would still save $3000 to $4000 [by] going to Ohio," he recalls.

Amish and Mennonite communities typically shun health insurance, and many are even exempt from Obamacare. Instead, they pay cash for medical care and often will travel all over the United States or internationally for better prices.

Now, in Truman's community in Putnam County, Missouri, the Amish and Mennonites are leading an effort to get affordable prices close to home. They've teamed up with a small, rural hospital here to develop a new model of more transparent healthcare pricing.

Read the full article.

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Rural Elderly

From Health Day

Elderly Americans who live in rural areas are at increased risk for health problems and death because of poor access to health care, a new study finds.

The researchers looked at 296 adults aged 85 and older living in rural and urban areas of Oregon. They found that rural residents had much higher levels of chronic disease, took more medications (average of 5.5 versus 3.7) and had a shorter median survival time (3.5 years vs. 7 years).

Compared to their urban counterparts, rural seniors were less likely to take medications for bone health, but more likely to take narcotic painkillers and high blood pressure medications. Both groups used a large number of over-the-counter products, including vitamins, minerals and herbal supplements, the study found.

Read the full article.

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Rural Publications

Estimated Costs of Rural Freestanding Emergency Departments
Since 2005, more than 100 rural hospitals have closed and more are at risk. Rural hospital closures jeopardize access to emergency services in the affected communities. As communities react to and/or prepare for closures, providers and policy makers seek a viable alternative for emergency services provided in a rural hospital setting. A rural freestanding emergency department (RFED) is one potential model for providing emergency services in areas where hospitals have closed. To inform the current policy discussion around RFEDs, The North Carolina Rural Health Research Program’s Findings Brief, Estimated Costs of Rural Freestanding Emergency Departments explains the concept of an RFED and estimates the costs of operating an RFED under three different volume scenarios. We have also created an Excel-based tool developed to assess the financial feasibility of converting a rural hospital into a freestanding emergency department. Download the FEDFAST tool

The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners
Although many medical schools incorporate distance learning into their curricula, assessing students at a distance occurs much less often due to the inherent challenges. This article focuses on lessons learned from implementing an objective structured clinical exam to address these challenges.

Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
In January, 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms (DSR) by making health care organizations more accountable for patients’ health as well as population and community health. Payment and delivery system reform, however, is concentrated in urban centers, and Medicare rural payment policies that were designed to strengthen rural health providers and systems are now complicating payment and delivery system reform in rural areas. The inclusion of rural providers in Medicare payment reform is critical for the program and for the 23 percent of Medicare beneficiaries who reside in rural areas. Rural Medicare beneficiaries should have the same opportunity as their urban counterparts to benefit from payment reform’s positive effects including strengthened primary care, embedded care coordination, and improved clinical quality. In this paper, we describe five recommendations to facilitate rural inclusion in value-based payment and delivery system reform.  For more information, see the Executive Summary

Geographic scope and accessibility of a centralized, electronic consult program for patients with recent fracture
Technology can be used in many ways to benefit rural residents. This article discusses an E-consult process used to improve bone health; comparisons between rural and urban clients is highlighted.

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Mark Your Calendar

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

January 27: Legislative Advocacy Day - Richmond
January 27: Transforming Clinical Practice Initiative - webinar
February 2-4: Rural Health Policy Institute - Washington, DC
April 6-8: National Health Outreach Conference - Roanoke
April 10-12: Mid Atlantic Telehealth Resource Center Annual Summit - Cambridge, MD

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Resources

How Medicaid Works
A Chartbook from the Commonwealth Institute to provide an easy to read summary of key information and data critical to understanding the program today and the opportunity to close Virginia's coverage gap

Webinar Recording Available: Impact of the CMS Value-Based Purchasing and Readmission Reduction Programs on Rural Hospitals
Dr. Ira Moscovice and Michelle Casey, MS with the University of Minnesota Rural Health Research Center discussed the impact of the CMS value-based purchasing and readmission reduction programs on rural hospitals. The Affordable Care Act authorized CMS to implement two programs focused on realigning hospitals’ financial incentives to provide high quality care: the Value-Based Purchasing program and the Hospital Readmissions Reduction Program. This webinar will describe the initial impacts of these two programs on rural Prospective Payment System hospitals. For more information, see the policy briefView the presentation online [Flash], View the presentation slides [PDF], View the transcript [PDF]

Private Well Owner Tip Sheet
Information on well inspections, water testing and educational opportunities.

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Funding Opportunities

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

Action for Nature: International Young Eco-Hero Awards
Action For Nature (AFN) is an international nonprofit organization that encourages young people to take personal action to better their environments and to foster love and respect for nature. AFN’s International Young Eco-Hero Awards recognize and reward the successful individual environmental initiatives of young people ages 8 to 16.

Walmart Foundation State Giving Program
The Walmart Foundation State Giving Program awards grants to nonprofit organizations at the state and regional level throughout the U.S. and Puerto Rico for programs that give individuals access to a better life. There are four funding cycles per year; nonprofit organizations in each state have two opportunities each year to apply. Applications will be accepted in all four funding cycles for programs within the scope of one of the following Focused Giving areas: Career Opportunity, Hunger Relief and Healthy Eating, or Disaster Preparedness. Organizations seeking funding for programs outside of the Focused Giving areas, and whose programs address the unmet needs of underserved low-income populations, can apply in cycles three and four only. Grants range from $25,000 to $250,000.

Scotts Miracle-Gro: GRO1000 Grassroots Grants
The Scotts Miracle-Gro Company’s GRO1000 Grassroots Grants help foster the development of gardens and green spaces in the United States. Grants of up to $1,500 are awarded to local communities throughout the country to help bring edible gardens, flower gardens, and public green spaces to more neighborhoods. The focus is on garden and green space beautification projects that incorporate the involvement and engagement of neighborhood residents and foster a sense of community spirit. Eligible applicants include nonprofit organizations, educational institutions, and government agencies. Applications will be accepted through February 22, 2016.  
TD Charitable Foundation Nonprofit Training Resource Fund
The TD Charitable Foundation’s Nonprofit Training Resource Fund provides support to nonprofit organizations in the communities served by TD Bank on the Eastern seaboard. Grants of up to $1,000 are provided for tuition costs for employees of nonprofit organizations to attend approved classes and courses that will enhance their job performance. Eligible organizations should have a mission or focus that promotes one of the following: affordable housing for low- to moderate-income individuals; increased economic (small business) development; financial literacy for low- and moderate-income youth, individuals, or families; or after-school or extracurricular programming for low- and moderate-income children. Requests are reviewed monthly. 

Lessons in Infection Control Initiative (LINC)
Awards funding to local health departments to improve healthcare and community infection control and improve capacity for responding to infectious diseases.
Geographic coverage: Nationwide
Application Deadline: Feb 5, 2016 

Accountable Health Communities Model
Grant objective is to test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid.
Geographic coverage: Nationwide
Letter of Intent (Required): Feb 8, 2016
Application Deadline: Mar 31, 2016 

Lowe's Toolbox for Education Program
Provides grants for school improvement projects, including school gardens, physical fitness areas, and walking trails.
Geographic coverage: Nationwide
Application Deadline: Feb 12, 2016 

Connections for Cardiovascular Health
Provides grants to nonprofit organizations working to improve cardiovascular health at the community level.
Geographic coverage: Nationwide
Application Deadline: Feb 25, 2016 

Small Health Care Provider Quality Improvement Grant Program (SHCPQI)
The purpose of this program is to provide support to rural primary care providers for planning and implementation of quality improvement activities.
Geographic coverage: Nationwide
Application Deadline: Mar 4, 2016 

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Virginia Rural Health Association
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Blacksburg, VA 24060
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