VRHA Weekly Update
In this Issue March 30, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter Available




VRHA and the ACA

Virginia Governor Terry McAuliffe told a group of health care professionals and advocates [including VRHA Executive Director Beth O'Connor and Board Member Neal Graham] gathered in Arlington to celebrate the fifth anniversary of the passage of the Affordable Care Act that after this state election cycle, he’s “reasonably optimistic” that the state legislature will back his push to enroll the state in the Medicaid expansion component of the act. He said that the argument in favor of the expansion is too strong simply from an economic development standpoint for reasonable Republicans, who’ve blocked it so far, to continue rejecting it.

But he said that any reasonable Republicans in the legislature are now fearing for “being Tea Partied” in their own GOP primaries if they came out for the expansion, so they will wait until after this year’s elections. All state senate and house of delegate seats will be up for election this November.

Meanwhile, over 400,000 Virginians are being kept from having health care coverage due to the Tea Party-inspired right wing opposition to expansion, and $1.7 billion in federal funds to Virginia to pay for it are being forfeited as a result. “In addition to the moral obligation we have, expansion of Medicaid in Virginia will be a huge economic driver and job creator,” he said.

Read the full article.

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Rural Health Works!

Research shows that community health services provide more than medical care. Rural health providers have a reciprocal effect on the community’s jobs, commerce, and overall economy.

How do you demonstrate that effect?  Through Rural Health Works!

VRHA is partnering with the National Center for Rural Health Works to provide a FREE webinar series on the economic impact of healthcare in rural communities.  Webinar schedule is:

  • April 30: Impact of a Community Health Center (FQHC) or Rural Health Clinic
  • May 28: Impact of a Small Rural Hospital

Visit the VRHA webinar page for details and registration.

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Members in the News

By SWVA.com

Optometry services are now being offered by [VRHA member] Southwest Virginia Community Health Systems Inc., a community health partnership serving people of this region with primary and comprehensive care.

All patients -- insured, uninsured and self-pay, including those who qualify for the sliding fee program -- may receive the services.

Read the full article.

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Virginia News

New Mental Health Plan

By Amy Trent - News & Advance

Since January, the Johnson Health Center has helped nearly 20 residents apply for Gov. Terry McAuliffe’s new mental health plan, an end run around his stymied efforts to expand Medicaid. The Governor’s Access Plan is a new Medicaid plan that provides uninsured Virginians with serious mental illness access to care and treatment. Virginia estimates some 54,000 residents need such services.

While the plan isn’t perfect, Johnson Health Center’s Chelsey Tomlin said she’s grateful to be able to offer it and is stepping up efforts to spread awareness.  Many were the working poor, who Tomlin describes as those working two jobs without health benefits from either; making too much money to get tax credits but too little to afford coverage; those getting Social Security but too young to qualify for Medicare benefits; and a lot of blended families.

Read the full article.

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Tobacco Control and Prevention

By Keltcie Delamar - AHA Mid-Atlantic

This session was a great year for education about the importance of reducing tobacco use as a way to lower the incidence of cardiovascular disease. Neither the House nor Senate budgets included the $3.5 million for the Virginia Foundation for Healthy Youth we requested for youth tobacco prevention programs. As a result of our work, however, we had great conversations with legislators and will continue to draw attention to this issue.
Legislators introduced various measures to raise tobacco taxes. Bill addressed raising the state tobacco tax from the current rate of $0.30/pack to $2.00 and allowing certain counties to increase the tobacco tax locally (currently only Arlington and Fairfax Counties and selected cities have this authority). Ultimately, all of the tobacco tax measures were defeated.

The Fifty Years War

By the Economist

The 50th anniversaries of the War on Poverty, which fell last year, and of the Appalachian Regional Development Act, passed in 1965, have prompted a debate about why some places cannot shake poverty. Both sides have taken up familiar positions. Republicans claim that Lyndon Johnson’s other war has been a failure: that the well-meaning programmes it spawned have trapped people in poverty rather than liberating them. Democrats, meanwhile, have leapt to the defence of federal transfer payments, and continue to put their hopes for the poorest bits of rural America in government-led economic development. It is possible that both sides are wrong.

Though the region has experienced many economic boomlets in the past—timber, salt, copper and gold all attracted opportunists before the coal boom of the beginning of the 20th century—Appalachia has been waiting for the next growth industry for a long time. The decline of coal jobs was well under way by the time the War on Poverty was launched. Mining enjoyed a mini-revival in the 1970s, during the oil shocks, but then resumed its downward trajectory. Natural gas and more abundant coal farther west have left Appalachia’s mines uncompetitive, a situation which locals are quick to blame on the Obama administration for waging a war on coal, with the Environmental Protection Agency as its infantry force.   

Even as Appalachia has grown richer, it has become sicker. The combination of diabetes and the outflow of young people has led to a widening of the difference with the rest of the country in mortality rates, which measure the number of deaths as a share of the population (see lower maps). Male life expectancy at birth in Perry County is just 66.5 years, about the same as in Mongolia. Female life expectancy is better, but it has declined by two-and-a-half years since 1985.

Read the full article.

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National News

Hospital & VA Victories

By Erin Mahn - National Rural Health Association

Among the amendments passed to the Senate Budget Resolution (S. Con. Res. 11) early Friday, was the National Rural Health Association-supported amendment No. 356 to allow the VA to provide veterans access to non-VA health care services when the nearest VA medical facility within 40 miles from a veteran’s home is unable to offer appropriate care for the veteran.

The budget also included language to make permanent the Medicare-dependent hospital (MDH) program and the low-volume hospital (LVH) adjustments. The House passed its own budget this week, and the two versions will need to be reconciled.

The Senate did not vote on the Medicare and CHIP Reauthorization Act before leaving for recess, but is expected to take action upon returning to Washington. 

Read the full article.

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Breaking the Camel's Back

By Mark Guydish - Times Leader

Less obvious forces are driving rural costs up. National Rural Health Association Senior Vice President for Membership Services Brock Slabach notes an often overlooked factor: Rural areas get shortchanged in “social services that are part of a network of care you take for granted in urban communities.”

Such care can include everything from a prenatal support group for expectant mothers to meal delivery for housebound elderly. The lack of social services bodes ill for rural hospitals as the “Hospital Re-admissions Reduction Rate” program created by the Affordable Care Act kicks in. The program punishes hospitals that have high readmission rates by reducing Medicare reimbursement, and Slabach said more than 2,000 hospitals are expected to take a hit in 2015.

Read the full article.

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Education at a Distance

By Kate Menzies - Rural Assistance Center

Rural communities are facing shortages of a major resource: healthcare professionals. Institutions across the country are seeking to address these issues by designing ways in which students can learn without having to leave their communities. These initiatives help rural communities “grow their own” healthcare professionals and allow rural workers to advance their careers. New advances in technology and information sharing have led some universities to move from the traditional classroom structure toward distance education courses and hybrid (distance/on-site) programs that allow professionals to keep working in their communities with minimal disruptions for coursework. This helps students take their newly acquired knowledge and skills back to the hospitals and clinics where they currently work.
Rural students often face challenges that inhibit them from attending traditional classes, according to Sue Skillman, Deputy Director of the WWAMI Center for Health Workforce Studies (WWAMI). Jobs, families and location can stop some students from pursuing degrees, Skillman said, but distance education courses give students an alternative to conventional classroom instruction.

Read the full article.

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Rural Publications

2014: Rural Medicare Advantage Enrollment Update
Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was nearly 1.95 million, or 20.3 percent of all rural Medicare beneficiaries, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million (20.4 percent) in October 2014. MA enrollment increased in both rural and urban areas despite reductions in payment and the conclusion of the MA bonus payment demonstration at the end of 2014.

Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians
Rural populations are struggling with opiod addiction compounded by a lack of facilities and personnel to help. Family physicians are the most important source of workforce, but can they address this complex problem? The authors supply an important study of buprenorphine treatment specific to rural family physicians.

Developing a culturally competent, sustainable rural model for diabetes prevention
Which is more important to outcomes, the family/community approach or the impact of health professionals? The authors explore these cultural and other issues with newly diagnosed diabetics in the US diabetes belt.

Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
The purpose of this brief is to describe the geographic variation in the use of EDs for non- emergent health conditions across rural and urban areas as well as by U.S. Census Regions. Potential risk factors including patients’ socioeconomic characteristics, geographic location and level of primary care resources are identified. Quality of care indicators, limited to wait times and the length of the visit for rural and urban EDs, are also addressed. 

Surgical Services in Critical Access Hospitals, 2011
This brief describes the types and volume of major surgical services provided in Critical Access Hospitals (CAHs) across four regionally representatives states in 2011. Of the surgery volume performed in CAHs, on average 77% was performed on an outpatient basis and 23% inpatient. Operations on the musculoskeletal system, the eye, and the digestive system accounted for 67% of all surgical procedures performed in CAHs. Most reports of surgery volume in CAHs focus on inpatient procedures, thus missing a significant portion of the surgery volume that CAHs perform. CAHs offering outpatient procedures that complement inpatient surgical capacity are providing the communities they serve significant and valuable services through access to both convenient and emergent surgical care services that lessen many of the health care burdens associated with travel for surgery and follow-up care. 

Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition
The patient-centered medical home (PCMH) model both reaffirms traditional primary care values such as continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access and also prepares providers to succeed in the evolving health care system by focusing on accountability, continuous quality improvement, public reporting of quality data, data exchange, and patient satisfaction. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). This policy brief reports findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discusses the implications of the findings for efforts to support RHC capacity development. 

Do Current Medicare Rural Hospital Payment Systems Align with Cost Determinants?
The financial performance of small, rural hospitals has long been a concern to federal and state agencies. Federal law makers have enacted legislation authorizing the Medicare program to develop reimbursement methods that provide higher payments to hospitals that serve rural communities (Critical Access Hospitals, Sole Community Hospitals, Medicare-Dependent Hospitals, and Standard Prospective Payment Systems hospitals). Current payment methods reflect legislative changes that have occurred since the rural hospital Medicare payment classifications were created more than 15-20 years ago. As a result, current rural hospital payment methods differ in eligibility criteria, adjustment factors, formulae, and timeliness of data. These differences may contribute to the variation in financial condition that has been found across the four types of rural hospitals. 

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Mark Your Calendar

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

April 1: Investing in Community Health Workers - Fredericksburg
April 8: Telemedicine for Rural and Critical Access Hospitals - webinar
April 8-9: Virginia Forum on Youth Tobacco Use - Richmond
April 22: Value-Based Modifier: Act Now to Avoid Payment Adjustments - webinar
April 30: Impact of a Community Health Center (FQHC) or Rural Health Clinic - webinar

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Worlds Apart: Poverty and Politics in Rural America
Shares new insights on the economic, demographic, and political realities reshaping poor rural communities. 

Expanding Medicaid: 22-State Data on Populations That Stand to Benefit
Infographic noting who would benefit if all states expanded Medicaid.

How Medicaid Works
A Chartbook for Understanding Virginia’s Medicaid Insurance and the Opportunity to Improve it

CMS MLN Connects™ Weekly Provider eNews 

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Funding Opportunities

Ronald McDonald House Charity of Charlottesville Grant Program 
Funding to organizations that enhance the health and well-being of children and their families.

EQT Foundation
The EQT Foundation supports nonprofit organizations in the communities that the company serves in eastern Kentucky, western Pennsylvania, and the states of Ohio, Virginia, and West Virginia. The Foundation gives priority to programs that address the following areas: The Education category focuses on providing economically disadvantaged students with greater access to programs that enhance proficiency in core academic skills. The Community category promotes the development of livable communities that can attract residential and commercial growth and sustain a healthy local economy. The Environment category supports the preservation of local natural resources as well as activities to minimize adverse impacts on the environment. The Arts and Culture category encourages initiatives that are designed to give economically disadvantaged youth more exposure to artistic programming, or that promote expanded awareness of the diverse culture and heritage of the regions where the company operates. The application deadlines are February 1, May 1, August 1, and November 1, annually.

Innovation in Caregiving Award
Funding to individuals who have invented a technique that solves a caregiving challenge, or found a new application of an existing device or technique that decreases the burden on caregivers.

Community Focused Eliminating Health Disparities Initiative
Application Deadline: Friday, April 10, 2015
Community Focused Eliminating Health Disparities Initiative (CFEHDI) is designed to work collaboratively to ensure implementation of an evidence based medical home model to close the gap in the health status of African Americans, Hispanics/Latinos, and American Indians. 

Now Is the Time Project AWARE-Community Grants
Application deadline:  Friday, May 1, 2015
Anticipated Award Amount: Up to $125,000 per year (Up to 70 awards)
The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, is accepting applications for fiscal year (FY) 2015 “Now is the Time” Project AWARE-Community (Short Title: NITT-AWARE-C) grants.  The purpose of this program is to support the training of teachers and a broad array of actors who interact with youth through their programs at the community level, including parents, law enforcement, faith-based leaders, and other adults, in Mental Health First Aid (MHFA) or Youth Mental Health First Aid (YMHFA).

Accelerating Community-Centered Approaches in Health
Applications accepted on an ongoing basis.
Funding amount varies.
The Kresge Foundation offers “Accelerating Community-Centered Approaches in Health” to support innovative population health programs and policies that work to improve health at the community level, including the use of new financial models to achieve cost effective solutions.  There is a two-step application process. The first step requires applicants to fill out an online application. Foundation staff will review the information provided and then invite selected applicants to submit additional information. 

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