VRHA Weekly Update
In this Issue November 10, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities

Win an iPhone 6 - Take the survey!

The Commonwealth of Virginia - led by Secretary of Health and Human Resources William A. Hazel, Jr., MD and Secretary of Technology Karen Jackson - has launched its fifth annual online Health IT Survey. The results of the survey are a critical benchmark used by Federal and State policymakers to assess the value of investments in Health IT, and show Virginia’s national leadership in areas such as Telemedicine and EHR utilization. 
All Virginia healthcare professionals who complete the survey prior to Friday, November 21 will automatically be entered to win a random drawing for an iPhone 6!
The survey takes approximately 5 minutes to complete, and can be accessed at http://bit.ly/2014HealthITSurvey.  The survey does NOT need to be completed at your medical practice facility.  If you have questions about the survey, contact Broad Axe Technology Partners





Veterans Administration:
Developing Community Partnerships


The Rural Health Team was established in 2010 to do outreach to assist Veterans with enrollment into the VA healthcare system. Partnerships were formed within Salem’s 26 county catchment areas. Over the years the Rural Health Team identified barriers and misinterpretations that prevented Veterans from enrolling into health care. It was also determined that Veterans did not receive the health education about their ailment or illness due to travel and time limitations. The Rural Health Team was challenged to identify the problems, construct a plan, act on the plan and identify the outcomes.

Join speakers BrendHart RN MSN and Lorna Oldson RN-C BSN for this great session at the VRHA Annual Conference!  Click the logo above for details about the event.

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Deadline Approaching!

The 2014 VRHA Conference will be held at the Stonewall Jackson Hotel & Conference Center. Rooms are set aside at the discounted (government) rate of $83/night (+ tax, fees & parking) for the conference. You must reserve by November 12th to ensure a room at this rate.

Reserve a room online or call 540-885-4848 and ask for the VRHA Conference rate.

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Members in the News

VRHA Member Mid-Atlantic Telehealth Resource Center has announced the agenda for their 2015 Summit:  Shaping the Future of Healthcare through Innovation and Technology.  The 2015 MATRC Telehealth Summit will explore how the partnership of human innovation and technological advancements is both shaping and transforming the future of healthcare. Join us as we take a closer look at the role of telehealth in a world that is moving from a traditional encounter based model of care that rewards volume to a new value-based, data-driven, patient-centered care model that rewards improved patient and population-based health outcomes.

The event will be held at the Greenbrier in White Sulphur Springs, WV March 29-31. 

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Virginia News

Safety Net Breaking

That popping sound you hear is Virginia's health care safety net stretched to its fullest, leaders say.  Virginia's health care safety net is groaning under increased demand, and a simple cash infusion won't solve the problem for free clinics and community hospitals around the state, industry leaders told legislators.  More cash certainly wouldn't hurt, though. A relatively small portion of free clinic budgets comes from state coffers now, according to presentations offered up to a state Senate subcommittee.

Altogether, the free clinics and community health centers that make up the state's safety net treated 235,000 uninsured Virginians in 2013, according to Deborah Oswalt, executive director of the Virginia Health Care Foundation.

"Quite an achievement," she said. "Except when you compare it to the number of people that are actually eligible.… It's only about a third."

Oswalt and others laid out some baselines for senators in the health care debate that continues to take up a lot of the bandwidth in Richmond, even with Medicaid expansion a seemingly dead issue. Without the billions in federal funding that would have paid for health insurance for hundreds of thousands of Virginians, providers are looking for a plan B.

Read the full article.

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Access for Veterans                    

From the Office of the Governor

Governor Terry McAuliffe convened a Summit on Veterans Health Care Access, bringing together top leaders from the U.S. Veterans Health Administration, state officials and private medical providers to work together on improving the availability of services to Virginia’s nearly 800,000 veterans. 

Participants in the summit discussed possible solutions that could be implemented through the Veterans Access, Choice and Accountability Act. The legislation approved by Congress promises $10 billion over three years to build partnerships with private providers with the goal of improving access to care for veterans facing significant barriers, including individuals who live 40 miles or more from a VA facility and those facing a waiting period of 30 days or more for a medical appointment. Governor McAuliffe’s “A Healthy Virginia” plan makes drawing down federal resources to expand access to care for veterans a top priority. 

Read the full press release.

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Close to Home

By Jennifer Ferris - North Carolina Health News/MedPage Today 

Set back behind a car dealership, just off what passes for a main drag, Ahoskie Pediatrics fills a squat brick building that has seen better days. The landscaping is meager, and the parking lot pavement is worn and faded. Inside, the brightly lit waiting room is clean and cheerful, filled with well-loved toys from decades past.

By many measures this is a pediatric practice that shouldn't exist. Ahoskie is home to 5,000 people, only 1,200 of whom are under 18. The median income of the town hovers right around the federal poverty level, and the bulk of the young residents qualify for Medicaid or the state's children's health insurance program, free school lunch, and other services. Beverly Edwards, MD, is one of only two pediatricians within a 2-hour drive of Ahoskie, and never has a shortage of patients.

More than 80% of Edwards' patients use Medicaid as their primary insurance. In Hertford County, where Ahoskie is located, more than 27% of the area's 25,000 residents are eligible for Medicaid, a number 10 points higher than the statewide average. Young children in Hertford have an even higher rate of Medicaid enrollment, with more than a third using the state-run health program.

Read the full article.

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National News

Election Takeaways

By Maggie Elehwany, JD - National Rural Health Association

Tuesday was another fascinating exercise in democracy and while there is much to analyze, the significant takeaway is this: Rural America continues to turn a brighter shade of red as the rural/urban electorate seemingly grows further and further apart. The expanding rural/urban divide could even be seen in not-so-rural states like Maryland who shockingly elected only their second Republican Governor in nearly 50 years. This is entirely because the voter turn-out was low in Baltimore but high in eastern and southern Maryland, the rural portions of the state. 

So, what does the Republican take-over in the Senate mean for NRHA’s rural agenda? Let’s look at the changes in chairmanships…

  1. Senate Finance - Wyden (D-OR) will lose his Finance Chairmanship to Orin Hatch (R-UT). Hatch is from a rural state, but hasn’t always been the champion of rural health issues that NRHA would like to see. We will need a strong ground-game with Utah’s rural providers to convince the new Chairman to step up his game.

  2. Senate HELP - Harkin (D-IA) retires from Senate HELP and either Lamar Alexander (R-TN) will or Mike Enzi (R-WY) will take the gavel. (Enzi has seniority and can choose the Chairmanship if he wants.) Both are fairly strong rural health advocates.

  3. Senate Approps - - Mikulski steps down and Cochran will likely take the chair (Shelby (R-AL) is next in line but likely will go to chair the Senate Banking Committee.) This is good news - - and the equally good news is that Sen. Moran will likely become the Subcommittee chair of L-HHS. (This is the one Senate Committee where subcommittees are a big deal.) Both are strong rural champions. Hopefully with Cochran and Moran we can firm up funding for rural health safety net programs, such as Flex grants, NHSC, AHECs, etc., etc.

Read the full blog.


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Small Hospitals/Big Challenges

By Paul Sisson - UT San Diego

In a way, it is remarkable that Fallbrook Hospital held on as long as it did.  The financial pressures that will ultimately close the 47-bed facility on Nov. 17 have forced nearly 100 other hospitals in California out of business since 1996.

It has become difficult for small hospitals like Fallbrook to cover ever-increasing overhead costs and broker deals with private insurance companies that want to work with medical providers able to care for thousands of subscribers. The Affordable Care Act has only intensified that pressure, experts said. It is a pressure felt every time patients must leave their neighborhoods and receive treatment 20 or 30 miles away.

Read the full article.

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Outpatients Paying More

Many Medicare beneficiaries treated at primarily rural “critical access” hospitals end up paying between two and six times more for outpatient services than do patients at other hospitals, according to a report released by the inspector general at the Department of Health and Human Services.

Brock Slabach, a senior vice president at the National Rural Health Association, said this issue has been raised before by the Medicare Payment Advisory Commission, or MedPAC, which counsels Congress. He said that because the law requires that critical access hospitals be paid their “reasonable” costs plus 1 percent, Congress would either have to change the law or Medicare would need to pay more to make up for the lower patient portions. 

“The reason this hasn’t been solved is it would require the Medicare program to subsidize more,” Slabach said.

Read the full article.

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Mental Health Provider Shortage


Rural communities in central and southern Indiana are battling a shortage of mental health professionals that is increasing wait times and forcing providers to triage cases to focus on the most urgent needs. Many patients are facing wait times of up to three months as facilities struggle to recruit psychiatrists and nurse practitioners with the ability to prescribe medication.

The situation is being compounded by an aging psychiatrist population — the average age is 55 — and a decline in the number of medical students pursuing the field, often because other specialties carry higher salaries and reimbursement rates. An increase in people with mental health insurance coverage through the Affordable Care Act and a reduced stigma for those seeking help also are factors.

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
November 14: 
How Sweet It Is! Addressing Diabetes in a rural setting
December 11 & 12: Virginia Rural Health Association Annual Conference - Staunton
February 3-5: Rural Health Policy Institute - Washington, DC
March 29-31: 
Shaping the Future of Healthcare through Innovation and Technology - White Sulphur Springs



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The Centers for Medicare & Medicaid Services (CMS) has restructured the Quality Improvement Organization (QIO) Program to further enhance the quality of services to Medicare beneficiaries. Effective August 1, 2014, KEPRO is the new Beneficiary and Family Centered Care QIO (BFCC-QIO) for the state of Virginia. Previously, the QIO in Virginia was Virginia Health Quality Center (VHQC). KEPRO will strive to keep a local presence by having outreach staff throughout the area and using state-specific physician reviewers, whenever possible, to provide review determinations at the local level. The same beneficiary protection services will continue to be provided to Medicare beneficiaries. This includes the right for a Medicare beneficiary and his/her representative to contact KEPRO:
       •  To file a quality of care complaint about the quality of health care received from a Medicare provider.
       •  To file a discharge appeal when a beneficiary is being discharged from a hospital or skilled services
          (including a skilled nursing facility, home health services, or hospice).
       •  For assistance with an immediate problem by requesting Immediate Advocacy. 

CMS MLN Connects™ Weekly Provider eNews 
October 9
October 16
October 23
October 30

Healthcare Access in Rural Communities
Topic guide by the Rural Assistance Center

Bright Futures in Practice: Oral Health 
The National Maternal & Child Oral Health Resource Center has released the second edition of the resource "Bright Futures in Practice: Oral Health - Pocket Guide." The guide is designed to be a useful tool for dental and medical professionals to address the oral health needs of pregnant and postpartum women, as well as infants, children and adolescents.

School Health Index
elps you assess your school’s health practices, create a customized action plan, track your progress from year to year, and get support to make healthy changes that align with federal requirements.   

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Funding Opportunities

Susan G. Komen: Walgreens Patient Navigation Program
Susan G. Komen’s mission is to save lives and end breast cancer forever by empowering others, ensuring quality care for all, and energizing science to find the cure. The Walgreens Patient Navigation Program, a new grant initiative of Susan G. Komen, supports cancer-specific, community-based patient navigation programs for patients diagnosed with an abnormal finding after an initial imaging test. Proposed programs should focus on coordinating and improving access to and timely utilization of breast health services through the Breast Cancer Continuum of Care (Screening, Diagnosis, Treatment, and Follow-up Care) at any point after an abnormal breast imaging test. Grant applicants may request up to $200,000 to support a two-year program. The deadline for letters of intent is November 19, 2014; invited full applications are due December 17, 2014. 

The Purpose Prize
The Purpose Prize, sponsored by Encore.org, awards at least $100,000 each year to people over 60 who are taking on society's biggest challenges. The prize recognizes those with the passion and experience to create new ways to solve tough social problems. Nominees, who may be working for organizations in the nonprofit, public, or private sectors, must be legal residents of the U.S. or U.S. citizens living abroad who have initiated important innovations in an encore career. The nomination deadline is January 15, 2015.

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.

Service Area Competition Funding for Health Center Program (Areas Served with a Project Period Start Date of June 1, 2015)
Application deadline: Dec 3, 2014
Funding to provide comprehensive primary health care services to an underserved area or population.

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.

Transforming Clinical Practices Initiative - Support and Alignment Networks
Letter of Intent (Optional): Nov 20, 2014
Application deadline: Jan 6, 2015
Awards funding to medical professional associations, specialty societies and for the establishment and operation of Support and Alignment Networks (SAN), which will offer support, technical assistance, and dissemination venues for Practice Transformation Networks. The aim of SAN is to promote best practices and models of care that are quality driven.

Rural Health Network Development Planning Grant Program
Funding for needs related to planning and establishing integrated healthcare networks with the goal of strengthening or expanding access to essential healthcare services.
Application Deadline: Jan 9, 2015

Cadence, Inc. Community Giving Program
Deadline: 12/15/2014  
Funding to organizations with a focus on vocational/technical education, local capital campaigns, or community giving within Staunton, Waynesboro, and Augusta counties.

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