Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  December 14, ,2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


December newsletter available





Budget Hearings

Buget hearings for the Govenor's proposed 2016-2018 biennial state budget have been scheduled for Thursday, January 7th.  The purpose of the hearings is to receive comments on the Governor's proposed amendments to the 2016-2018 biennial state budget.

VRHA is anticipating that some form of Medicaid expansion will be included with the proposed amendments.  We are encouraging all members to attend one of the regional meetings and speak in support of closing the coverage gap.

The full public hearings notice can be found here, along with instructions on submitting written comments if you are unable to attend in person.

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Members in the News

By Tammy Childress - Herald Courier

[VRHA member] Lonesome Pine Hospital has added of another service that will expand the continuum of care available for the community. Representatives of the hospital, Wellmont Health System and the community celebrated the opening on an intensive care unit with a ribbon-cutting ceremony  Nov. 17. 

In recent years, Lonesome Pine has also added a sleep evaluation center, expanded and renovated The Birthing Inn and opened a wound care center with hyperbarics.

Read the full article.

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More Members in the News

By Linda Burchette -SWVA Today

[VRHA member] James Tyler, CEO of Smyth County Community Hospital, didn’t mince words and didn’t apologize for what he called a “somber” address at Thursday night’s chamber of commerce annual dinner meeting. Tyler’s subject was drug abuse and its dangerous effect on the county. He referenced The Music Man’s lyrics, “Well, ya got trouble, my friend, right here, I say, trouble right here in River City. Trouble with a capital ‘T’.”

He went on to describe patients in the hospital emergency department high on meth, going through heroin detox, suffering from skin infections caused by using dirty needles, and the dramatically increasing level of HIV/AIDS in the community.

“If we are going to face this issue we need to do so with a unified front,” he said. “We need a standard policy and random drug testing.” Local government needs to address the drug abuse problem as an issue, he said, and citizens need to acknowledge that this is a real issue that’s just getting worse.

Read the full article.

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Virginia News

Penny Wise

By Massey Whorley - The Commonwealth Institute

State spending on Virginia's Medicaid will be $789 million higher the next two budget years than the base for this year, in part because people who have been eligible, but not yet enrolled, signed up for coverage. This is not a surprise. In fact, these new estimates are in line with the state's budget writers' previous projections. What's more, the new estimates demonstrate just how much the refusal to close the coverage gap is costing Virginians.

More people are enrolling, in part, because of the push to connect people with coverage. Ads and news stories are encouraging people to sign up to secure the financial protections of health insurance and avoid the increasing federal penalty. So more people are signing up for coverage, and that's a good thing because people with health insurance are more likely to receive recommended preventive care that reduces preventable deaths.

The issue for Virginia is that the state has to pay more for many of the new enrollees than it should. Had Virginia taken the commonsense approach -- like 30 states and the District of Columbia -- and closed the coverage gap, the federal government would have paid 100 percent of the cost for many of the new enrollees through 2016. That's because many of the new enrollees only qualify for the state's bare bones family planning coverage, which requires the state to pay more than if Virginia had allowed these same folks to get full Medicaid. If the state decided to close the coverage gap, its own cost would be nothing through 2016 for these people, only 5 percent in 2017, and 6 percent in 2018.

Read the full article and related editorials from the Richmond Times Dispatch and Del. Ken Plum.

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No Wrong Door

From the Office of the Governor

Governor Terry McAuliffe announced  that Virginia has been awarded nearly $3 million in federal funding to help ease difficulties older adults and people with disabilities may face when they seek support services from state agencies, health care systems and community organizations. The Department for Aging and Rehabilitative Services won two grants from the Administration on Community Living to expand Virginia’s No Wrong Door system and further streamline access to long-term services that allow individuals to remain in the community.

No Wrong Dooris a public-private partnership between multiple state agencies and private providers. It aims to help consumers who need critical home- or community-based care to find those services in their communities, while simplifying the complexities of the process.State agencies partner with more than 60 providers to share electronic records that can identify services to benefit older adults and individuals with disabilities, reducing repetitive paperwork, and saving time and money, while improving access to public and private services.

Read the full press release.

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Catawba & Piedmont Recommendations

By Luanne Rife - Roanoke Times

 state report recommends lawmakers close Catawba and another state psychiatric hospital in favor of adding a wing to a newer facility and building a network of community services, especially those that care for people with dementia. The report by the Virginia Department of Behavioral Health and Developmental Services was ordered by lawmakers in this year’s appropriations act. The department was charged with evaluating the cost of operating the 110-bed Catawba Hospital in Roanoke County and the 123-bed Piedmont Geriatric Hospital in Southside and exploring other options.

In the report to chairmen of the Senate and House appropriations committees, dated Nov. 10, the department said it “found it necessary to consider PGH and Catawba in the broader landscape of the other state-run hospital facilities and community-based services.” 

It found that Virginia spends nearly half its mental health dollars on inpatient care at eight state-run hospitals, leaving little to build a community-based network of care that could treat people before their illnesses worsened to the point of hospitalization, and to follow through with their care upon discharge.

Read the full article.

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National News

NRHA Leadership 

By Alex Olson - National Rural Health Association 

Leadership for the National Rural Health Association is secure for 2016 and beyond, thanks to recent elections for Board of Trustees and Rural Health Congress positions and the selection of candidates for NRHA’s Rural Health Fellows program. 

NRHA members chose David Schmitz, MD, as president-elect. Schmitz, Family Medicine Residency of Idaho chief rural officer and director for rural training tracks, will assume the duties of NRHA president in 2017.

NRHA is pleased to announce all individuals elected by their peers to serve in leadership roles. NRHA is also proud to announce its 10th class of Rural Health Fellows (including VRHA member Robert Alpino!).

Read the full article.

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Teleneurology & Stroke Care

By Stephanie Dickrell - St. Cloud Times 

In some rural areas, recovering stroke patients no longer have to make the long drive to St. Cloud Hospital for follow-up appointments.  At these appointments, staff check motor skills, asking patients to push, pull and squeeze with their hands and feet. They also check cognitive abilities.  Now, the evaluation can be supervised by a neurologist who is at St. Cloud Hospital, 55 miles away.

Experts hope the program will raise the percentage of patients who go to their follow-up appointments. That could mean reductions in re-hospitalizations within 30 days, reductions in the degree of disability and improvements in the quality of life. It could also increase the frequency of follow-up appointments.

Read the full article.

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Preserving Emergency Care 

By MedPAC staff 

The MedPAC Commission has consistently stated that rural beneficiaries’ access to emergency services needs to be preserved. Since January 2013, there have been 41 hospital closures in rural counties and rural parts of urban communities. It is both the concern over maintaining access to care and concerns over inefficiencies in the current delivery system that motivated the Commission’s October session on preserving rural access to emergency services.

The Commission, researchers, and rural advocates all agree that, in certain circumstances, preserving emergency access will require supplemental payments beyond standard fee-for-service (FFS) rates. Currently, Medicare has several rural payment models that are designed to preserve rural hospitals. For example, the Critical Access Hospital (CAH) program provides cost-based rates to providers that maintain inpatient services, the Sole Community Hospital (SCH), and the Medicare Dependent Hospital (MDH) programs both provide higher prospective inpatient rates. Currently, the majority of rural hospitals receive payment through the CAH program. Despite these models, rural hospitals are still closing.

Given the concerns over closures and inefficiencies in current payment models, the Commission has begun discussing new payment models that would allow some rural hospitals that are struggling to maintain emergency access for their communities to voluntarily switch to providing only outpatient services. The Commission has started investigating whether Medicare dollars for inpatient care could be redirected to subsidizing emergency services at rural hospitals. At it’s October meeting, the Commission discussed two potential new models for emergency care in rural areas. Both options are intended for isolated (meaning a certain distance from another emergency department) hospitals that voluntarily elect to close their inpatient departments. 

Read the full article.

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Rural Publications

Geographic Distribution of Oncologists and Travel Distance
Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. 

Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals 
Compared to hospitals in expansion states, those in nonexpansion states provided greater amounts of uncompensated care as a percentage of revenues and appeared to be more financially vulnerable; thus, these hospitals may be more likely to experience financial pressure or losses.

Rural Enrollment in Health Insurance Marketplaces, by State
In this brief, we provide comparisons between cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas of each state and corresponding percentages of “potential market” participants enrolled, controlling for Medicaid expansion status. We show that in several states, non-metropolitan enrollment rates exceed metropolitan enrollment rates, a finding that is obscured in an aggregate comparison. This analysis provides some indication of how well outreach and enrollment efforts targeting rural populations are proceeding in the states. 

Rural Hospital and Physician Participation in Private Sector Quality Initiatives
Some private sector quality initiatives could potentially have a significant impact on the quality of rural health care, particularly in rural markets that are dominated by a single large insurer, as these insurers are likely to have both the resources to implement an initiative and sufficient leverage to motivate rural provider participation. This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles twelve different initiatives (half focused on physician quality improvement, half focused on hospital quality improvement). 

Accuracy of Remote Hearing Assessment in a Rural Community 
The current study demonstrates the validity of using synchronous telemedicine for conducting hearing assessments in a remote rural agricultural community without a sound booth.

Implications of Rural Residence and Single Mother Status for Maternal Smoking Behaviors
Findings from this study indicate that rural mothers are significantly more likely than their urban counterparts to be smokers, smoke frequently, and smoke heavily, even after adjusting for factors known to increase smoking risk. The authors suggest that methods for extending insurance coverage for smoking cessation interventions through the Affordable Care Act and Medicaid be considered. Additionally, anti-smoking initiatives at the local, state, and national levels could play an important role in decreasing rural-urban disparities in smoking-related morbidity and mortality. 

Access to HIT Training Programs at the Community College Level
Successful implementation of health information technology (HIT) in rural areas depends on the availability of a well-trained HIT workforce, and community colleges are key educational resources for producing this workforce. This study examined HIT workforce development programs in community colleges in order to increase understanding of the types of programs offered, describe the characteristics and sources of community college HIT curricula, highlight how these programs may be reaching underserved populations and students with limitations to accessing classroom-based courses, and identify barriers faced by these programs in achieving their HIT education goals. Information about the strengths and needs of the nation’s community college HIT education programs should help inform future HIT skills training programs and contribute to growing and strengthening the HIT workforce. 

Recruitment and retention of mental health care providers in rural Nebraska
Mental health providers and administrators are the experts regarding recruitment and retention of key mental health personnel. What do they say about the challenges of providing mental health in rural Nebraska?

Rural Disabled Medicare Beneficiaries Spend More out-of-Pocket 
The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey to evaluate rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service. The proportion of total spending paid out-of-pocket is 40% higher among rural disabled Medicare beneficiaries compared to urban disabled beneficiaries. Rural disabled and elderly beneficiaries are more likely to go without any form of supplemental coverage than urban beneficiaries. 

Rural Adults Delay, Forego, and Strategize to Afford Their Pre-ACA Health Care
About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. 

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Mark Your Calendar

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

December 14: Federal Monitoring and Oversight Surveys in the Physical Environment - webinar
December 15: Rural Solutions to Online Education: 
December 16: Improve Care for Chronic Patients - and Leverage CPT 99490 - webinar
February 2-4: Rural Health Policy Institute - Washington, DC
April 10-12: Mid Atlantic Telehealth Resource Center Annual Summit - Cambridge, MD

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Social Determinants of Health (SDOH) Website
CDC resources for SDOH data, tools for action, programs, and policies.

Health in All Policies (HiAP) Resource Center 
One-stop-shop that provides practical resources and tools for collaboration across sectors to achieve policies that impact community health. 

CDC Community Health Improvement Navigator 
Tools and resources to support nonprofit hospitals, public health, and community stakeholders throughout the health improvement process.

Are You Ready to Begin a Capital Project? A Guide, Toolkit and Resources for Critical Access Hospitals and Rural Health Centers
Determines organizational readiness of Critical Access Hospitals and Rural Health Clinics as they proceed through the process of developing capital projects, and helps them prevent any drawbacks due to an inadequate plan. The manual is divided into two major sections: Self-assessment provides tools to identify current capabilities and weaknesses that can be used as a starting point to build a capital project; and External Influences provides tools to examine patient population and the community’s demand for services and healthcare trends to ensure the capital project is responsive to current and future needs.

Smart Rural Community
Resources focused on broadband availability and implementation, designating towns as a "Smart Rural Community." Includes white papers, videos, webcasts, and access to models that can be followed to create your own rural telecommunications hub.

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Funding Opportunities

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

Connecting Kids to Coverage Outreach and Enrollment (Cycle VI)
Grants to organizations that help families with children enroll in health coverage opportunities, including Medicaid, CHIP, and insurance affordability programs.
Letter of Intent (Required): Dec 16, 2015
Application Deadline: Jan 20, 2016

Emergency Medical Services for Children State Partnership Regionalization of Care Grants
Provides funding to develop systems of care that increase access to emergency medical services for children in rural, territorial, insular, and/or tribal communities.
Application Deadline: Jan 20, 2016

Systems for Action
The Robert Wood Johnson Foundation is launching its first call for proposals to identify and study system innovations that improve the reach, quality, efficiency, and equity of health services, particularly as it drives collaboration and integration among the health care and other systems (e.g. transportation, education, urban design).
Deadline:  January 12, 2016

Klingenstein Third Generation Foundation  
Deadline: 01/09/2016
Grants to major medical institutions for postdoctoral fellowships in child and adolescent ADHD and child and adolescent depression.

Paralyzed Veterans of America Education Foundation
The Paralyzed Veterans of America is dedicated to veterans’ service, medical research, and civil rights for people with disabilities. The Paralyzed Veterans of America Education Foundation supports educational projects that serve individuals with spinal cord injury and disease (SCI/D), as well as their families and caregivers. The Foundation’s five grantmaking categories include the following: Consumer, Caregiver, and Community Education; Professional Development and Education; Research Utilization and Dissemination; Assistive Technology; and Conferences and Symposia. Members of academic institutions, healthcare providers and organizations, and consumer advocates and organizations throughout the United States and Canada are eligible to apply for grants of up to $50,000. The application deadline is February 1, 2016.

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