Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue January 5, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


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Members in the News

From Northern Neck News

Bon Secours Virginia Health System and [VRHA member] Rappahannock General Hospital (RGH) announced  that Bon Secours Virginia’s acquisition of RGH and its affiliated medical group and foundation will close on Dec. 31, making RGH Bon Secours’ eighth hospital in Virginia. The 450 workers who are currently employed by RGH will remain at the hospital as it is acquired by Bon Secours.

The two health care organizations entered into a clinical affiliation agreement in 2011 when a letter of intent was signed stating Rappahannock General Hospital would become part of the Bon Secours Virginia Health System. Throughout the clinical affiliation agreement, RGH remained an independent community-based hospital. The success of the clinical affiliation agreement led to a nonbinding letter of intent in 2014, designed to complete a transaction pursuant to which RGH and its entities would become part of the Bon Secours Virginia Health System. The approval of the acquisition comes as a result of a vote by the hospital’s board of directors, which is made up of local community leaders.

Read the full article and related articles in the Richmond-Times Dispatch, the Washington Post, and Richmond BizSense.

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More Members in the News

[VRHA member] Dave Nutter - Roanoke Times

Reforms enacted by the Affordable Care Act and the uncertainty surrounding closing the coverage gap in Virginia are creating new and unprecedented challenges for both rural and urban hospitals. While all hospitals must work within the confines of these hurdles, it is especially difficult for Virginia’s smaller, rural hospitals to weather the changes. One rural hospital has been forced to close, and others have cut back service lines, jobs and other resources.

Rural hospitals are struggling in the current environment because of the unique challenges posed by the larger socioeconomic trends in rural Virginia. Over the past 25 years, as the manufacturing, textile and mining industries have declined, rural Virginia has shifted demographically to an older and often less healthy population.

For example, age-adjusted chronic disease rates often are noticeably higher, with chronic lower respiratory disease deaths 59 percent higher in rural Virginia. Additionally, per capita income is lower in rural Virginia, while the percentage of low-income households, total population in poverty, and those not graduating high school are all significantly higher. As a result, nearly 80 percent of patients seen in a rural hospital are either uninsured or receive their health care through a federally funded program such as Medicaid or Medicare.

That is a staggering figure. To put it another way, only 20 percent of patients at rural hospitals are commercially insured. Rural hospitals can only expect to be fully reimbursed for the costs of care for 20 percent of the patients they see.

Read the full editorial.

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Virginia News

Legislative Watch

Bills recently introduced by the Virginia General Assembly which could have an impact on health and healthcare in rural Virginia.

SB 760: Medicare supplement policies for individuals under age 65. Requires insurers issuing Medicare supplement policies in the Commonwealth to make standardized Medicare Supplement Plans A and C available to any Medicare enrollee under 65 years of age who is eligible for Medicare due to disability or end-stage renal disease. A Medicare supplement policy issued to such an individual may not exclude benefits based on a preexisting condition if the individual has a continuous period of creditable coverage of at least six months as of the date of application for coverage. The enrollment period for an individual is the six-month period following the month the individual became eligible for Medicare or during the 63-day period following termination of coverage under a group health insurance policy. 

HB 1458: Naloxone; administration in cases of opiate overdose. Allows a prescriber to prescribe naloxone to a patient for administration to a person other than the patient when the patient believes the person is experiencing or is about to experience a life-threatening opiate overdose and allows a person to possess naloxone and administer naloxone to a person experiencing or about to experience a life-threatening opiate overdose. The bill provides that a person who administers naloxone to another person under such circumstances shall not be liable for civil damages and that a prescriber shall not be civilly or criminally liable for injuries resulting from the prescription of naloxone to a patient for administration to another person. The bill also allows emergency medical services personnel and other first responders to possess and administer naloxone pursuant to a standing order or oral or written protocol, and provides that first responders and members of emergency medical services personnel who administer naloxone pursuant to a standing order or oral or written protocol shall not be civilly or criminally liable for injuries resulting from the administration of naloxone.

SB 717: Board of Health; medical school scholarships. Expands eligibility for the medical school scholarship program administered by the Board of Health for medical students who agree to practice in underserved areas of the Commonwealth to include students of any accredited medical school. Under current law, only students who attend medical schools in Virginia are eligible for the scholarship program. 

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Gap Is Unaffordable

By Elizabeth Simpson - the Virginian-Pilot

The army of counselors who help people sign up online for insurance in the Affordable Care Act marketplace this open enrollment period face a range of reaction.  The sessions usually end in gratitude - and sometimes insurance for someone who has been going without a safety net. But occasionally there's frustration, even anger, from people who find the premiums and deductibles in the federal marketplace too much for their pocketbook.

Many of the disappointed fall into the so-called "coverage gap," those whose incomes are below the lower limit for subsidies on the marketplace but above the Medicaid eligibility line.  Virginia decided not to expand Medicaid, the state-federal insurance for low-income and disabled people - which would have covered up to 400,000 Virginians - and it already had one of the toughest eligibility standards in the country, sixth-most stringent by one report.

Read the full article.

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Revisiting the Debate

By Dan Heyman - Public News Service 

Although the Republican leadership in the General Assembly is frowning on it, Democrats and the governor are reopening Virginia's debate on expanding Medicaid. One reason it won't go away is because federal money available to close a big gap in Virginia's healthcare coverage would also close a big gap in the state budget.

As Michael Cassidy, president with The Commonwealth Institute puts it, the state is leaving federal money on the table. Funds he says Congress or the other states will gladly spend.
Governor Terry McAuliffe's budget plan counts on the more than $200 million in new federal Medicaid funding to close a budget gap of more than $300 million. But expanding Medicaid under Obamacare is very unpopular with much of the Republican majority in the Legislature. 

Read the full article.

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National News

Aging Tsunami

By NBC News

The sunny Tuesday after Memorial Day marked another funeral in Circle, Montana.  Patti Wittkopp has been to more this year than she could count on two hands. As she prepared that morning to bury 85-year-old Gene Huseby, one of her first patients as a nurse in this small town in Eastern Montana, she was again reminded that this community she poured her heart into is growing old.

Now a physician's assistant, Wittkopp has for 14 years been the closest thing to a doctor in McCone County, one of twelve counties in Montana that has no doctor at all. From inside her little health center, she has watched a demographic shift that is sweeping across Montana--what officials here have dubbed an "aging tsunami."

Almost 25 percent of McCone County residents are over 65. Years are now conspiring to include Wittkopp among the aging. At 60, she is concerned less that she is slowing down - she hasn't, much - and more with the fact that she cannot be sure that when she hangs up her stethoscope, the system she poured her heart into will remain.

Read the full article.

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No Stand-Alone ERs

From the Valdosta Daily Times

Months after Georgia allowed struggling rural hospitals to scale back their operations to save money, not a single facility has signed on.  Gov. Nathan Deal’s administration intended that unprofitable rural hospitals could scale back their services and just offer emergency care and a few outpatient services. Public health officials said reduced care was better than no care at all if a rural hospital closed. 

Hospital executives were skeptical the plan would save much money. This fall, financial consultants told a state committee that freestanding emergency rooms would probably take a loss, likely discouraging any hospital from pursuing it.

Read the full article and a related story from the Peach Pundit.

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Using Technology for Rural Vets

By Sandra Jontz - Signal Online

Technology plays a central role in helping the Department of Veterans Affairs (VA) work smarter, not harder, to medically treat veterans, particularly those who live in rural areas of the nation. The Veterans Health Administration steered the use of telehealth technology, which now lets cardiac patients heal at home, and might one day help cancer patients avoid long drives to VA hospitals for follow-up care, says Tom Klobucar, deputy director for VA's office of rural health. “Our office of telehealth services actively engages in looking for enterprise-level technological solutions to the questions of access.”

The office launched a telephone-based cardiac rehabilitation program a few years ago, for example, for rural veterans in Iowa who had difficulty accessing cardiac rehab. The veterans received at-home exercise equipment such as stationary bikes or pedometers, and participated in weekly phone calls with cardiac nurses who assessed their progress and helped with lifestyle changes to promote better health.

Read the full article.

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Automated CPR

By Marcus Traxler - Forum News Service 

The newest addition to the Avera Weskota Memorial Hospital emergency room is always at the ready. And its hospital colleagues know it will correctly do its job every time.The Wessington Springs hospital recently received its Lucas 2 chest compression device, which is a machine that senses the size of a patient and delivers standard CPR compressions to help resuscitate a patient who has suffered cardiac arrest and showing no pulse or is unconscious.

Once the patient is situated inside the device, the machine works on its own and gives automated and continuous CPR. That's a big deal for a small hospitals and EMT units. It allows two more hands to be freed up to help with installing an IV or check the patient's airway.

"It's huge," said Christina Christensen, a registered nurse at Avera Weskota. "There's only two nurses here 24/7, so in times where there's only a few employees, this is going to be a very important part of our care."

Read the full article.

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Mark Your Calendar

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

February 3-5: Rural Health Policy Institute - Washington, DC
March 29-31: Shaping the Future of Healthcare through Innovation and Technology - White Sulphur Springs
April 8-9: Virginia Forum on Youth Tobacco Use - Richmond

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Webinar recording available: The 2014 Update of the Rural-Urban Chartbook
Alana Knudson, PhD from the North Dakota and NORC Rural Health Reform Policy Research Center presented findings from The 2014 Update of the Rural-Urban Chartbook in a webinar on December 9, 2014:

The Chartbook presents information on population demographics, health-related behaviors and risk factors, age-specific and cause-specific mortality, access to care, health insurance coverage, mental health, and other health-related topics for U.S. residents across levels of rural and urban status.

Coding for ICD-10-CM: More of the Basics (video) 
Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. 

Community Health Workers in Rural Settings 
Visit this new guide to learn more about community health workers (CHWs) in rural communities, the training they need and roles that CHWs can fill in rural settings. The guide was developed by RAC information specialist, Kathleen Spencer, with input from Diana Abeyta, Office of Community Health Workers, New Mexico Department of Health; and Susan Mayfield-Johnson and Carol West, American Public Health Association 

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Funding Opportunities

Predoctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene
Application deadline: Feb 2, 2015
Awards funding for predoctoral training programs that are designed to educate predoctoral dental students, dental hygiene students, and dental hygienists, preparing them to practice in new and emerging models of care that are designed to meet the needs of vulnerable, underserved, and rural populations.
Sponsor: Bureau of Health Workforce

Advanced Nursing Education Grants
Application deadline: Feb 13, 2015
Grants for projects that support the enhancement of advanced nursing education and practice. Awardees will create or enhance partnerships between academic institutions and rural or underserved clinical practice sites to improve student readiness to enter those areas upon graduation.
Sponsor: Bureau of Health Workforce

Testing Multi-Level Interventions to Improve Blood Pressure Control in Minority Racial/Ethnic, Low Socioeconomic Status, and/or Rural Populations (UH2/UH3)
Letter of Intent (Optional): Jan 13, 2015
Application deadline: Feb 13, 2015
Awards funds for research initiatives designed to reduce disparities in hypertension among high risk populations, including racial/ethnic minority groups, patients with low socioeconomic status, and individuals residing in rural areas.
Sponsor: National Institutes of Health

Healthy Eating Research - Healthy Food Retail and Early Care and Education
Letter of Intent (Required): Jan 7, 2015
Application deadline: Mar 4, 2015
Supports research on environmental and policy strategies designed to promote healthy eating among children to prevent childhood obesity, especially among groups at highest risk for obesity: Black, Latino, American Indian, Asian/Pacific Islander children, and children who live in lower-income communities.
Sponsor: Robert Wood Johnson Foundation

USDA Community Facilities Loan and Grant Program
Application deadline: Applications accepted on an ongoing basis.
Funding to construct, enlarge, or improve essential community facilities for healthcare, public safety, education, and public services in rural areas.
Sponsor: USDA Rural Development 

ADA Foundation Accepting Oral Health Education Grant Applications
Deadline: Jan. 30, 2015
The ADA Foundation (ADAF) is now accepting applications for its Semi-annual Grants Program with a focus on oral health education. Grants of up to $5,000 will be awarded to nonprofit organizations whose work aligns with the ADA Foundation's mission to improve the oral health of the public through education. 

Perinatal and Infant Oral Health Quality Improvement Expansion Grant Program
Deadline: Feb 27, 2015
Estimated Award Amount: Up to $250,000 per year
This funding opportunity announcement (FOA) solicits applications for the Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Expansion Grant Program, the second phase of the Perinatal and Infant Oral Health National Initiative. The goal of this grant program, as with this multi-phase initiative, is to reduce the prevalence of oral disease in both pregnant women and infants through improved access to quality oral health care. By targeting pregnant women and infants most at risk for disease, during times of increased health care access, the expected result is improved oral health and oral health care utilization of the mother and her child throughout their lifespan. 

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