Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  November 2, 2015

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



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VRHA News

Go Vote!

There’s an important Election Day in the Commonwealth of Virginia tomorrow, November 3, 2015. Casting your ballot (and encouraging friends and family members to vote) this year will have a direct effect on important health and healthcare decisions in Virginia. Make sure you know the position of who you are voting for. Exercising your rights as a citizen ensures your voice is heard!

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RHC Regional Meetings

The next step in VRHA's Rural Helth Clinic Coalition development process is to host regional meetings.  Meeting schedule will be:

November 10 – Luray
November 12 – South Hill
November 17 – Stuart
November 18 - Lebanon

The meetings will be from 10am – 3pm with lunch provided (download draft agenda). 

Click here to register. There is no charge for Virginia RHC staff to attend.

More information about the Rural Health Clinic project can be found here.  If you have any questions about VRHA or the Rural Health Clinic project, please don't hesitate to contact Beth O'Connor (540-231-7923).

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Members in the News

VRHA Member Virginia Hospital & Healthcare Association has kicked off the "Our Lifeline" campaign (the link has all the details on the campaign, a sign-up form, and a compelling video). From the VHHA campaign site: “Virginia hospitals and health systems are there for us in moments of need. They support thousands of local jobs, our economy, and protect public health. Those benefits are threatened by mandates and cuts from Washington, and inaction in Richmond.”

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Virginia News

Griffith Pushes Telehealth

By Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio) - The Hill

Rep. Griffith: When I was serving in the Virginia House of Delegates, one of my fellow delegates experienced a significant stroke while at an event we were attending. Fortunately, another colleague, a neurologist, realized what was happening and rushed to his aid. Our colleague received the clot-busting drug tPA and was back on the House floor within a few days.

Because time is so important to stroke patients, we recently introduced bipartisan legislation to ensure that all Medicare beneficiaries who suffer a stroke can have access to quick, high quality stroke care using telemedicine, now commonly called “telestroke.” Our bill, the FAST Act – the Furthering Access to Stroke Telemedicine Act (H.R. 2799) – would change an outdated provision of law that currently allows Medicare to cover a telestroke evaluation only when the patient is located at a rural hospital. Yet, 94 percent of stroke patients live in urban or suburban areas and face many of the same barriers to speedy care – lengthy travel times to a hospital, lack of available stroke specialists, and no awareness of stroke warning signs. According to the American Academy of Neurology, there is currently an 11 percent shortfall of neurologists, with that shortfall projected to increase substantially over the next decade. We believe that all Medicare beneficiaries deserve access to fast, high quality stroke treatment, regardless of where they live. 

Read the full editorial and a related review.

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Support for Closing the Gap

By Rebecca Park - Commonwealth Institute

The evidence is mounting that Virginians want more people in the state to have health insurance and the peace of mind that comes with it. The latest news is a new survey that found 74 percent of likely Virginia voters say they want state lawmakers to accept federal dollars to close the coverage gap. That's a lot of voters.

They believe that providing quality, affordable health coverage for their fellow Virginians is simply the right thing to do and think it's wrong that Virginia lawmakers continue to leave 195,000 constituents out in the cold.

Read the full article and related editorial from the Virginian Pilot.

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National News

Disappointment in Budget Deal

By Erin Mahn Zumbrun - National Rural Health Association

Congressional leaders and the White House reached a tentative budget deal that would raise the debt limit, avoid a shutdown in December, and would set spending levels through September 2017.

The National Rural Health Association is disappointed that the Bipartisan Budget Act of 2015 includes site-neutral payment cuts on hospital outpatient departments (HOPDs) and the extension of sequestration for Medicare payments. Rural hospitals play a critical role in providing 24/7 access to care and are the safety net providers for rural America.

The extension of the 2 percent cut in Medicare payments, which was first passed under the sequester, comes during a time when rural hospitals are already closing because of drastic cuts.

Read the full blog.

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CAH Growth

By Michael Sandler - Modern Healthcare

Despite the outcry on Capitol Hill over rural hospital closings, the number of critical-access hospitals in the U.S. grew slightly in the past year, according to Modern Healthcare magazine's annual review of CMS data. The uptick—there were 1,333 critical-access hospitals as of Sept. 1, 2015, up from 1,321 in 2014—could be a product of hospitals in some states dropping in size to enable them to switch their payment designation from the prospective payment system to critical-access.

Support for critical-access hospitals has been in the Obama administration's crosshairs for several years. This past year, the president's budget proposed eliminating the extra 1% of payment over costs that go to the hospitals. The extra money is justified on the basis of their unstable volumes and high rates of lower-income patients. Eliminating the extra payments, as well as critical-access status for several hospitals, would save taxpayers $2.5 billion over the next decade.

But experts say keeping access to care in remote areas is crucial. With a high rate of uninsured people in rural areas and the lack of Medicaid expansion in some states, a solution must be found, said Alan Morgan, CEO of the National Rural Health Association. 

Read the full article.

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Preserving Emergency Care

From AHA News Now

The Medicare Payment Advisory Commission discussed policy options October 9th to preserve access to emergency care in rural areas in the wake of recent rural hospital closures. Staff presented two potential models that would allow rural prospective payment system and critical access hospitals to convert to a 24/7 emergency department or primary care clinic with 24/7 ambulance service. Hospitals choosing the ED-only model would receive hospital outpatient PPS rates per service and fixed grants to help pay for standby capacity costs, while payment for the clinic model would be similar to a federally qualified health center.

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Rural Publications

Area Deprivation is Higher Among Rural Counties—but Not All Rural Counties are Deprived
This brief is the first of two in a series that provides policy makers and interested parties with information on the role of residence and community deprivation on potentially avoidable hospitalizations among children. This brief describes the development of the area deprivation index, examines area deprivation across all U.S. counties, and describes findings when applied to rates of potentially avoidable hospitalizations among a nine-state sample of children. 

The Intersection of Residence and Area Deprivation: The Case of Hospitalizations from Ambulatory Care Sensitive Conditions Among Children
This brief is the second in a series providing information on the role of residence and community deprivation on potentially avoidable hospitalizations among children. This brief describes the findings from a nine-state sample of children’s hospitalizations and discusses the potential implications for rural health research and policy. 

Determinants of an urban origin student choosing rural practice: a scoping review
The shortage of physicians in rural and remote communities is an ongoing problem. Many studies have shown that the rural background of a student (ie rural origin) is a primary factor in recruiting physicians for practice in rural communities. Scoping reviews are primarily done to gague the extent of literature on the research question at hand, typically with an intent that future research in that area is a constructive addition to pre-existing knowledge. This scoping review focuses on factors that predispose urban-origin students to choose a carrier in rural medicine.

Post-discharge Rehabilitation Care Delivery for Rural Medicare Beneficiaries with Stroke
Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States (U.S.). Post-discharge care has been shown to be vital in preventing long-term morbidity and improving functionality and quality of life for stroke patients. The most appropriate post-discharge rehabilitation care (PDRC) setting for stroke patients depends on several factors including the patient’s clinical profile, patient preferences, provider recommendations, and proximity to available resources. Limited evidence suggests geographic as well as racial and ethnic disparities in receipt of PDRC. 

Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time?
The Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmissions Reduction Program reduces Medicare payments for hospitals determined to have “excess” rates of patient readmissions for specific conditions. The purpose of this project was to assess rural-urban differences in the proportion of hospitals that received penalties under the Readmissions Reduction Program over time, and whether condition-specific hospital readmission rates differed for rural and urban hospitals. 

Free Clinics in the Rural Safety Net, 2014
This brief explores two issues. First, we examine where free clinics are located and describe their availability in rural counties across all 50 states. This information was derived from clinic listings on the website of the National Association of Free and Charitable Clinics (NAFC). Second, through telephone interviews with leadership at 14 of the 21 state free clinic associations, we explore issues facing free clinics during the current period of change. Issues examined include perceived changes in demand subsequent to implementation of the Affordable Care Act and different funding models and strategies used by free clinics. 

Obesity and obesity-related behaviors among rural and urban adults in the USA
Obesity continues to progress in an epidemic fashion in the United States. Studies have indicated more problems for rural populations. Additional studies can help to confirm or deny the rural contribution as well as indicate other possible reasons.

Comparison of rates of emergency department procedures and critical diagnoses in metropolitan and rural hospitals
Emergency physicians are one of few types of physicians increasing in the rural United States. The authors ask questions about the preparation of emergency physicians and the differences between training in rural and in urban settings.

Perceived ease of access to alcohol, tobacco and other substances in rural and urban US students
The purpose of the present study was to examine rural–urban differences in perceived ease of access to alcohol, smoking and chewing tobacco, marijuana, and seven other substances in the US state of Georgia in order to better inform and promote future substance use prevention and programming efforts in rural areas.

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Mark Your Calendar

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

November 13: VOHC Conference, Achievable Wellness: Engaging Communities and Clinicians for Better Health - Richmond
December 3: TCI Policy Summit - Richmond
February 2-4: Rural Health Policy Institute - Washington, DC

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Resources

ICD-10: 26 Tips You Absolutely Want to Know!
The 10th edition of the International Classification of Diseases (ICD-10) is upon you! Chances are you've been preparing, but the magnitude of the changes coming seems overwhelming to many physician practices. To help you manage the transition more easily, here is an A to Z of 26 tips that can help you become more comfortable and more efficient with ICD-10.

Atlas of Rural and Small-Town America
A compendium of statistics on people and jobs in rural areas as well as factors that impact local economies such persistent poverty, economic dependence and population loss.  

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Funding Opportunities

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

Career Development Grant
Deadline: 12/15/2015
Grants of up to $12,000 for women who, through additional higher education, technical training, or participation in a professional development institute, are making career changes, seeking to advance in their current careers, or re-entering the workforce.

Russell Sage Foundation
Deadline: 01/05/2016
Two-year grants of up to $150,000 will be awarded to qualified organizations for  the improvement of social and living conditions in the United States.

Improving Healthcare Systems Research Grants
Offers funding to research the comparative effectiveness of innovative features of healthcare systems (e.g. use of innovative technology, deployment of personnel, incentives, organizational policies) that affect quality, outcomes, and/or efficiency of care. Studies that examine effects on certain populations, including low-income and rural populations, will receive priority.
Geographic coverage: Nationwide
Letter of Intent (Required): Nov 12, 2015
Application Deadline: Feb 16, 2016

Academy of General Dentistry Foundation Grant Program
Supports programs that offer access to quality oral health care outreach for underserved populations.
Geographic coverage: Nationwide
Application Deadline: Dec 1, 2015

Solid Waste Management Grant Program
Offers funds to organizations to provide technical assistance that will reduce or eliminate pollution of water resources in rural areas, and improve planning and management of solid waste sites in rural areas.
Geographic coverage: Nationwide
Application Deadline: Dec 31, 2015

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