VRHA Weekly Update
In this Issue  September 11, 2017

VRHA News Virginia News National News Mark your calendar
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Healthcare Workforce Pipeline

By Mickey Powell - Martinsville Bulletin

Southern Virginia needs doctors and nurses. That's not a surprise. But the problem is growing, local officials say, to the point local practices aren't just willing to hire newly-graduated students, but also need for them to start working basically as soon as their credentials are placed in their hands. 
The problem is also getting people trained for available jobs.

Read the full article, then join the Virginia Rural Providers Conference for a discussion about the Healthcare Workforce Pipeline.  Ward Stevens from the Edward Via College of Osteopathic Medicine will lead the conversation.

Click the logo to the right for full event details.
October 25 & 26
South Boston, VA

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Members in the News

By Luanne Rife - Roanoke Times

The Trump administration ordered the National Academies of Sciences, Engineering and Medicine to stop studying whether mountaintop removal mining in Central Appalachia poses a health risk to people living nearby.

Last month, [VRHA member] Susan Meacham, a professor of preventative medicine at Edward Via College of Osteopathic Medicine in Blacksburg presented findings from yearslong research that compares deaths and diseases in Virginia’s coalfields with other parts of the state. 

“The NAS study is serving a very important function in a very balanced and professional process,” Meacham said. “The NAS committees are highly respected, so we hope they will be able to continue the review and assessment of work currently available on surface mining and human health.”

Read the full article and a related report from the National Toxicology Program.

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More Members in the News

From the Richmond Times Dispatch

Gov. Terry McAuliffe recently announced the following appointments -
Virginia Health Workforce Development Authority:

  • Ralph R. Clark III of Richmond, associate dean for clinical activities and chief medical officer at Virginia Commonwealth University School of Medicine and chief medical officer at VCU Health System;
  • [VRHA member] R. Neal Graham of Henrico, CEO of Virginia Community Healthcare Association; and
  • Lori Rutherford of Roanoke, nurse practitioner at the Veterans Health Administration.

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Virginia News

Innovative Diabetes Treatment

From SWVA Today

A diabetes treatment clinic is bringing new jobs to Tazewell County. Trina Health of Pounding Mill announced Aug. 10 that it will open an innovative diabetes treatment center in a 2,400 square foot building across the road from WalMart. The clinic will implement a treatment known as “artificial pancreas treatment from Triana Health LLC founded by G. Ford Gilbert in California.

The treatments will be available to patients with. Both type 1 and type 2 diabetes. The treatment is different from others because it reverses the Comorbidities associated with diabetes.

Services include neuropathy, non healing wounds, kidney disease, retinopathy, heart disease and others. The local company has already hired eight full time people and hopes to increase its staff to 21 in five years.

The Virginias Coalfield Economic Development Authority loaned the group up to $400,000 to get started. They also received $90,000 as a grant from the Tobacco Region Opportunity Fund and another $45,000 as a loan.

Read the full article and a related story from Virginia's e-Region.

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Overdose Vigil

By Melinda Williams - Southwest Times

Every 12 minutes someone in the United States dies from a drug overdose. In fact, more people died from overdoses in 2016 than were killed in traffic accidents or gun deaths, according to federal statistics.

To draw attention to the drug overdose crisis, particularly overdoses involving opioid drugs, New River Valley residents were invited to attend a candlelight vigil at Bisset Park in Radford.

Read the full article.

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Close to Home

By Rose Farah - Daily Yonder

The Sapling Center is a drop-in youth safe space, created by Kentucky River Community Care in August 2016. All young adults between the ages of 14 and 25 are welcome at the two existing centers in Whitesburg and Hazard, but programming is targeted towards individuals in crisis situations. The centers serve coalfield counties in Kentucky’s Fifth Congressional District, an economically troubled and rural region.

Mental health treatment facilities are less common in rural areas than they are in urban ones. A 2013 study conducted by Indiana University School of Social Work found that approximately 55% of rural counties in the United States do not have a psychologist, psychiatrist, or social worker who specializes in the treatment of mental health.

Read the full article.

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National News

Hepatitis C Spike

By Christine Vestal - Stateline

In an unrelenting opioid epidemic, hepatitis C is infecting tens of thousands of mostly young, white injection drug users, with the highest prevalence in the same Appalachian, Midwestern and New England states that are seeing the steepest overdose death rates.  

But advocates for syringe exchanges say the prospect of standing up enough clean needle programs in the nation’s hardest hit communities to stem the spread of hepatitis C is daunting. 

Unlike the AIDS epidemic of the 1980s and previous drug epidemics, which were spawned and defeated in urban settings, this opioid epidemic is ensnaring people who live in far-flung small cities and rural communities with few public health resources and scant political will to provide sterile needles to illicit drug users. 

Read the full article.

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Lack of Treatment Options

Dori Davis - Duluth News Tribune

A mentally ill person should not be treated for the disease in an emergency room. Or sitting in a jail.  But that is what often happens in rural Minnesota, where there are not enough health care professionals such as psychiatrists to treat them. And there are not enough psychiatric hospital beds even if the professionals were available.
About 20 percent of Minnesotans have some form of mental illness, but just about half of them receive treatment.  Often what happens to the mentally ill is they get arrested and stay in jail for two days, the maximum allowed under state law, and then are transferred to an emergency room.

Read the full article.

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No Bandwidth = No Telemedicine

By Craig Settles - Daily Yonder

Stephen Morris recalls his father’s battle with Parkinson’s disease. One thing hasn’t changed, however. Broadband may still determine whether rural residents are telemedicine’s “haves” or “have nots.”

“He was in a rural county where they have general MDs and a hospice within 10 miles,” Morris said. “But specialists were over two hours away. My family would have appreciated telemedicine. Several times my brother or I had to leave work, drive down, and help Mom take Dad to the closest equipped hospital that was an hour from where they lived.”

Morris is principal of FoothillsNet, a broadband consultant for rural America. He believes telemedicine is incredibly difficult, if not impossible, without broadband. “I envision teleconferences with medical specialists hours away giving advice in real time and adjusting medicines to reduce costly ER visits and hospital stays,” he said.

Read the full article as well as the U.S. Government Accountability Office (GAO) report showing that low uptake of telehealth services may be due to regulatory restrictions and inadequate reimbursement and payment methods.  The GAO found that Medicare, with many beneficiaries in rural areas, lags behind other federal programs in implementing telehealth services.

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Rural Publications

Rural and Urban Utilization of the Emergency Department for Mental Health and Substance
While research has identified general utilization and cost of emergency care for mental health and substance abuse (MH/SA) services, little research specifically addresses rural utilization, and rural populations at greater risk of utilizing the ED for a MH/SA diagnosis. Utilizing data from the Healthcare Cost and Utilization Project’s (HCUP’s) State Emergency Department Databases (SEDD) for seven states, researchers explored and described the use of the ED for MH/SA among Urban, Large Rural, Small Rural, and Isolated Small Rural residents. The proportion of ED visits with a primary MH/SA diagnosis increased nationally. While results indicate that utilization is lower among the more rural U.S. residents, individuals utilizing the ED for MH in rural communities share different characteristics than those in urban areas, which subsequently may impact cost of care, and proposed interventions. 

CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars is the Problem
In April 2017, the Centers for Medicare & Medicaid Services (CMS) released their fourth Hospital Quality Star Rating list. Since the first release, stakeholders have been publicly debating the star rating scale’s usefulness in comparing hospital quality, but little focus has been given to the large number of rural hospitals with no rating. The brief looks more closely at the characteristics of rural hospitals with and without quality star ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative. The data in this brief highlight a limitation in using the Hospital Quality Star Rating to compare quality either among rural hospitals or between rural and urban hospitals. More than one third of rural hospitals did not receive a star rating, compared with 12% of urban hospitals. Among rural hospitals, CAHs and very small hospitals (lowest net patient revenue) were least likely to receive a star rating. Rural hospitals without a star rating were clustered across the West, Midwest, and South Census Regions. It is important for consumers, policy makers, and other stakeholders to know that the disproportionate amount of missing data limits the conclusions that can be drawn from comparisons of the rural hospital quality star ratings. 

Correlations between community size and student perceptions of value
Medical student professional development has been linked to their participation in patient care. This study found a relationship between community size and the extent to which students felt valued and the likelihood of them participating in patient care. Perceptions of value and the likelihood of participation decreased as community size increased.

The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
The provision of post-acute care (PAC) and hospice care by rural hospitals allows patients to receive such care locally, avoiding unnecessary travel and staying close to family and friends. Typically, rural residents discharged from an acute care facility receive PAC either locally or in the urban center where acute care was provided. Policy makers are considering changes in how these services are reimbursed. These changes will increasingly affect Medicare reimbursement of rural hospitals if the number of rural PAC and hospice care providers included in Accountable Care Organizations (ACOs) and bundled payment contracts drops, or if more rural residents choose to receive PAC and hospice care in urban centers rather than closer to home. The purpose of this brief is to describe Medicare post-acute and hospice care provided by rural hospitals (or in rural areas) by characterizing 1) the variation in the number of rural hospitals that provide PAC and hospice care, 2) the average amount of Medicare revenue rural hospitals receive for these services, and 3) the financial importance of PAC and hospice care services to rural hospitals. The description of PAC and hospice care provided in this brief is meant to help highlight the potential impact a change in reimbursement might have on rural hospitals and their communities. 

A comparative analysis of policies addressing rural oral health in eight English-speaking OECD countries'
This study documents the limited focus on rural oral health that exists in national oral health policies from eight different English-speaking countries. It supports the need for an increased focus on rural oral health issues in oral health policies, particularly as increased oral health is clearly associated with increased general health.

Regional Differences in Rural and Urban Mortality Trends
Previous research has established both that there is a gap in nationwide urban-rural mortality and that this gap is increasing over time. Existing and ongoing work has found that the urban-rural mortality gap may vary regionally. This brief builds upon previous research and explores the differences in mortality trends between urban and rural locations by census division from 1999 to 2015. Using data from CDC WONDER’s Compressed Mortality File, we calculated urban and rural all-cause mortality rates in each of the nine census divisions. Confirming previous research, we found that rural mortality is higher than urban mortality in every year. Further, the difference between urban and rural mortality is increasing nationwide: The disparity after 2007 is larger than the disparity before 2007 in all nine census divisions. The urban-rural disparity also varies regionally; for example, rural mortality rates, and differences between the urban and rural mortality rates, are the highest in the Southeastern United States. The regional variation in the rural and urban mortality gap over time suggests that more research must be done to explain underlying causes of these disparities and to support the development of policies that can mitigate them. 

Improving Access to High Quality Sepsis Care in a South Dakota Emergency Telemedicine Network
Key findings of this study are: 1) Telemedicine consultation for emergency department (ED) sepsis care is rare, but a dedicated utilization initiative modestly increased use; 2) A multi-pronged approach of nurse-directed screening, recommended consultation criteria, and real-time hub decision-support were implemented in a large rural ED-based telemedicine network; 3) Appropriately balancing the sensitivity of telemedicine consultation recommendations is critical to limit alarm fatigue and identify patients most likely to benefit. 

Insights on the Coordination and Delivery of Home Health Services in Rural America
Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care. Rural home health agency administrators and discharge planners reported a variety of challenges with providing home health services to rural Medicare beneficiaries, including insufficient reimbursement, Medicare requirements, and recruiting and retaining an adequate workforce. External financial support, affiliation with a hospital, integrated EHR systems, and strong relationships with hospitals were identified as facilitators for providing rural home health services. The facilitators and challenges identified in this study offer insights about the delivery of home health services in rural communities that should be considered by policy makers, innovators, and providers as rural healthcare evolves. 

Rural-Urban Differences in Medicare Service Use in the Last Six Months of Life
Determining the medical appropriateness of care during the final months of life, as recorded in billing information, is difficult. Further, billing data do not record patient preferences and expressed wishes. However, assuming that patient preferences are similarly distributed across rural and urban beneficiaries, examining differences in care during this period suggests areas for possible improvement that might both reduce potentially inappropriate care and better comply with patient desires. Overall, rural decedents were more likely to have used outpatient clinic services and less likely to have used inpatient, ambulance, home health, and hospice services. It cannot be ascertained whether these differences result from patient preferences or from differences in facility availability, but they suggest a more conservative use of resources for rural decedents. Lower use of hospice services among rural residents may represent an opportunity to further reduce utilization of acute services. Participation in hospice care was found to reduce the likelihood of inpatient, SNF and ambulance use, while being linked to a greater probability of home-based care. 

Transitions in Care Among Rural Residents with Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia
The analysis reported here examines the continuum of care of Medicare beneficiaries as they experience transfers to other facilities, including their post-discharge status (death vs. discharge), post-discharge care (such as nursing home care, skilled nursing care, home health care, and primary care follow-up), and potentially preventable readmissions, either to their local hospital or another facility. Inpatient and outpatient claims data were drawn from the Medicare five percent sample files, 2013. To allow comparability across rural and urban patients, the study was restricted to beneficiaries admitted for congestive heart failure (CHF), acute myocardial infarction (AMI), or pneumonia. Patients were followed from their first billed encounter with a hospital, including patients who were seen at an emergency department at the initial hospital and immediately transferred to a second facility. 

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Mark Your Calendar

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

September 7: Empowering a Rural Community to Create a Culture of Health - webinar
September 11: REVIVE! Opioid Overdose Education - Abingdon
September 21: Financial Distress and Closures of Rural Hospitals - webinar
September 25 & 26: The Governor's Summit on Rural Prosperity - South Boston, VA
October 24 & 25: Rural Health Documentation & Coding Bootcamp  - South Boston, VA
October 25 & 26: Virginia Rural Providers Conference - South Boston, VA
November 12 & 13: Virginia Telehealth Network Summit - Richmond

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3RNet Recruiting for Retention Academy
Online educational opportunity to learn about tools and resources that can assist in recruiting qualified providers to rural and underserved areas.
Registration Deadline: Oct 2, 2017 

HRSA Look-Alike Initial Designation Technical Assistance
Technical assistance resources to assist organizations in the application for Look-Alike Initial Designation under the Health Center Program.

Annual Surveillance Report of Drug-Related Risks and Outcomes--United States, 2017
Summarizes latest information on opioid prescribing from 2006-2016; drug use, misuse, and substance use disorder from 2014-2015; nonfatal overdose hospitalizations and emergency department visits from 2014; and drug overdose mortality from 1999-2015. Features statistics with breakdowns by large metropolitan, small metropolitan, non-metropolitan urbanized, non-metropolitan less urbanized, and completely rural.

County Diabetes Data
Provides access to state, national, and county-level data and trends for diabetes, obesity, and leisure-time physical inactivity.

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Funding Opportunities

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

NBCC Foundation Rural Scholarships
Offers scholarships to students residing in rural areas who are currently enrolled in a master's level counseling program and are committed to practicing in rural communities after graduation.
Application Deadline: Oct 31, 2017 

Whole Kids School Garden Grant Program
Grants to support new or existing edible gardens at K-12 schools and nonprofit organizations.
Application Deadline: Nov 15, 2017 

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