VRHA Weekly Update
In this Issue  March 13, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Women's Health Virginia

Newsletter now available





Action Alert

The House Energy and Commerce Committee will take up legislation to repeal the ACA and restructure Medicaid. The only Virginia Congressman on this Committee is Morgan Griffith, Republican from the 9th Congressional district (Southwest Virginia). 

Whether you support or oppose the proposed changes, VRHA encourages you to contact Congressman Griffith and offer your opionion. Your voice as a rural health advocate is vital in this process.

PLEASE CONTACT CONGRESSMAN GRIFFITH'S OFFICE regarding the repeal of the ACA and restructuring of Medicaid. Reach out to his legislative aide at 1-202-225-3861 or kristin.Seum@mail.house.gov.

Reviews of the proposed legislation from various sources:

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Members in the News

By Luanne Rife - Roanoke Times

Dr. William Anderson, grandson of slaves who became president of the American Osteopathic Association — was the first black surgical resident at a segregated hospital. He led the Albany Movement alongside his friends Martin Luther King Jr. and Ralph Abernathy, and he was a founding board member of the [VRHA member] Edward Via College of Osteopathic Medicine in Blacksburg.

Oh, and he’ll be 90 come December, a fact easy to miss given the quick wit that elicited bouts of laughter from a classroom theater packed with second-year medical students. On the last day of black history month, Anderson offered VCOM students animated accounts of his life, spinning humor into tales of his struggles against discrimination.

Nearly half of the students come from small towns and rural counties of fewer than 30,000 people, and 16 percent of the students are from underrepresented minorities. VCOM is among the 10 U.S. medical schools with the highest African-American student enrollment.

Read the full article.

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More Members in the News

By Rachael Smith - News & Advance

What originally was dreamt up as a getaway room for patients with dementia and Alzheimer’s and Parkinson’s diseases now has become a favorite spot for all patients as well as some staff at Oakwood Rehabilitation and Health in Bedford.

Oakwood is located on the campus of [VRHA member] Bedford Memorial Hospital and provides intermediate and long-term care for patients needing recovery, rehabilitation and therapy.

Read the full article.

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Virginia News

Treatment, Not Jail

By Alane Callander - Fredericksburg.com

The Virginia General Assembly adjourned after passing a biennial budget that included substantial increases for mental-health services statewide. But Gov. Terry McAuliffe is not finished fighting for $4.2 million to provide local and regional jails the tools and training to perform mental health screenings and assessments. That’s a project “of highest priority” for the governor, who may dip into surplus funds later this year to cover the costs.

Because I know a mentally ill woman serving time in the Rappahannock Regional Jail, and I know of the conditions under which she lives, I praise Gov. McAuliffe for recognizing this critical need.

Releasing patients from large mental institutions was intended to be humane, but it has left local communities with huge challenges trying to treat and house those needy residents. Thankfully, the General Assembly just approved some additional money for community-based programs.

Read the full editorial and related commentary in the Daily Press.

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Therapy Dogs

By Jessica Griffith - News 5

These pups aren't your typical nurses. But workers at the Southwestern Virginia Mental Health Institute tell me the dogs are important to their patients health. We're told there's typically at least one dog at the institute every day, so if a patient needs one, they're there.

"We've seen many times how they'll relate to a dog before they'll relate to a human. And then they'll come on and start doing things and come out of their shell," Lesu Cole, recreation therapist said.

"I've seen other patients on there who can be crying or yelling, not angrily. And the dogs walk on the ward and immediately they're quiet, they're smiling, they're interacting with the dogs," Psychologist Judy Britt said.

She credits animal therapy for a breakthrough with a long-term patient who had a stroke and was non-verbal.

Read the full article.

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Appalachia Needs Single-Payer

By Katie Lee - Johnson City Press

We are all aware that the recent election is likely to bring change in the health care system of this nation, but we have a choice to make. During these tumultuous times in health care policy, the way forward is not to strip 20 million Americans of their health care by repealing the Affordable Care Act  without a replacement. Instead, we should pursue the most equitable and just option — a single payer health care system.

The United States remains the only developed country with for-profit insurance companies and only one of three developed nations that does not guarantee health care. We are spending the largest amount per capita ($8,000 plus) on health care expenditures of any nation in the world, but without the best outcomes.
The leading cause of bankruptcy in the United States is medical bills, and an estimated 45,000 deaths annually can be attributed to lack of health insurance. Over 100 million Americans forgo professionally recommended medical care due to cost each year. Clearly, we have work to do. A single-payer system by way of a Medicare-for-All structure would allow coverage for all Americans and would actually reduce spending.

Read the full editorial.

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National News

Go Big

By Alan Morgan - National Rural Health Association

Rural health care should obviously be a focus for the new Administration. In his first address to Congress, President Trump called on Congress to work together “to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and at the same time, provide better health care.”

The National Rural Health Association urges the Administration and Congress to make health care work in rural America. A large policy initiative on rural health care means:

1.) Jobs.  In most rural communities, rural health care represents the largest, or second largest, employer in the community.  If you are bringing jobs back to the middle class, an investment in solving the chronic workforce shortages plaguing rural America is a no-brainer. During the Great Recession, rural counties were shedding 200,000 jobs per year and rural unemployment stood at nearly 10 percent.  Economic recovery hasn’t returned to rural America.  In fact, 95% of the jobs that have returned after the Great Recession have been to urban, not rural areas.

2.) Investment in infrastructure.  Rural hospitals are closing across the U.S. at an alarming rate. Already 80 rural hospitals have closed and right now, 673 additional facilities are vulnerable and could close—this represents more than 1/3 of rural hospitals. Many of these facilities are dated – built in the 1950s – and were designed for care from a bygone age.  A new program for improved access to broadband, technology grants, and access to capital, seems like a solid way to achieve the stated goal of rebuilding our aging infrastructure.

3.) Low costs – high returns. Rural Medicare payments represents a rather small portion of the overall Federal health care budget.  By stopping devastating Medicare cuts and proposing targeted Medicare increases for rural providers, the new Administration can point to an immediate improvement in access to care for rural America. A January 2017 CDC study indicates that “the death rate gap between urban and rural America is getting wider.”  The rates of the five leading causes of death — heart disease, cancer, unintentional injuries, chronic respiratory disease, and stroke — are higher among rural Americans. Access is key to addressing these health care disparities.

4.) New payment models. Rural America has demonstrated the ability to provide quality care, and now is time to invest in new demonstration projects targeting rural populations. To create economic vitality in rural America – to make rural America work again –  the rural hospital closure crisis must end. Stopping Medicare cuts to rural hospitals, as in the Save Rural Hospital Act, will stabilize rural hospitals, stabilize rural communities and create a new model for rural hospitals.   

5.) Don’t forget the forgotten.  Rural America voted for Trump - Election exit polls indicate that rural America voted for Donald Trump 3 to 1. In many cases, this vote represented a loss of hope among a population which has long been overlooked and marginalized, the rural middle class, and rural low income.  A rural health focus demonstrates that this administration “gets it” and plans to take action on their behalf.  This includes empowering both the White House Rural Council and the Centers for Medicare and Medicaid Rural Council to identify burdensome regulations ensuring that rural America has a strong voice within the vast federal government.

So, the question is not whether the new Administration will launch a rural health initiative, but rather why would they choose not to engage? Rural America matters, and it’s time for all policy leaders to recognize the new reality.

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A Cap on Opioids

By Markian Hawryluk - Wescom News Service

Oregon lawmakers are considering a bill that would limit initial prescriptions of opioid pain medications to just seven days in a bid to prevent addictions and overdose. The limits in the bill mirror prescribing guidelines developed by the Centers for Disease Control and Prevention and modified by an Oregon task force to meet the needs of the state.  

Although the bill provides for exceptions for patients with legitimate ongoing need for prescription opiates, the limits on prescribing have many chronic pain patients worried. B.J. Cavnor, director of 1-in-4 Chronic Health, said particularly in rural areas, requiring patients to come back after a week to refill their prescription could have unintended consequences. 

Read the full article.

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Repeal Consequences

By Shefali Luthra - MedCity News

Judy Keller, 69, has always relied on Highlands Hospital in Connellsville, Pennsylvania, for medical care, just as her parents did before her. When she walks through the halls, she recognizes faces from the community and even from her days working as a school teacher. The 64-bed facility, she says, is a mainstay of this rural Southwest Pennsylvania town.

But in the wake of this fall’s presidential election, Highlands — like many other rural hospitals — will likely face new financial challenges that will intensify longstanding struggles, experts say. The Affordable Care Act, which President Donald Trump has vowed to repeal, threw a number of life-savers to these vital but financially troubled centers. And its full repeal, without a comparable and viable replacement, could signal their death knell.

Highlands provides one window into how some of these shifts could reverberate in small towns across the country. And ironically, 64 percent of people here in Fayette County — one of the state’s poorest — voted for Trump. Pennsylvania, which has the third largest rural population in the nation, played a pivotal role in his upset victory this fall.

Read the full article.

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Lifeline to Specialist Care

By Eric Wicklund - mHealth Intelligence

In America’s heartland, large cities and health systems are few and far between. So if a child needs a healthcare specialist, telemedicine may be a literal life-saver. At Children’s Mercy Kansas City, 26 of the hospital’s 47 pediatric specialties are now offered via a telemedicine network that reaches out across Kansas and Missouri, connecting with families who would otherwise have to drive several hours to see a specialist. The 367-bed hospital operates three fully owned telemedicine clinics staffed by trained nurse facilitators, with a fourth due to go on line shortly.

“Telemedicine is a lifeline,” says Morgan Waller, MBA, Children’s Mercy KC’s director of telemedicine. “And with demand just starting to exceed the need, it’s only going to get bigger.”

All told, these clinics serve about 150 children a month, giving them access to some of the country’s most in-demand doctors. Perhaps the best example of this lies in immunology, asthma and allergy. Children’s Mercy sees as many as 30 children a month, most diagnosed with asthma, through the telemedicine platform. Each visit includes a remote physical examination using digital tools, a medication check-up, and a discussion of an “asthma action plan” that encompasses home, school, day care and any other caregivers and locations that might be affected should the child have an asthma attack.

Read the full article.

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Mark Your Calendar

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

March 13: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services -    ​ Winchester​
March 15: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services - Harrisonburg​
March 16: Oral Health Care Access for Individuals with Special Health Care Needs - Woodbridge
March 17: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Roanoke
March 20: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Radford
March 22: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Wise
March 24: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Abingdon
March 27: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Martinsville
​March 29: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Richmond
March 29-30: 2017 Population Health Summit - Charlottesville
March 31: Utilizing Virginia Medicaid's Addiction and Recovery Treatment Services  - Charlottesville
April 2-4: MATRC Telehealth Summit - Leesburg
May 9-12: 40th Annual Rural Health Conference - San Diego, CA
May 9-12: Rural Hospital Innovation Summit - San Diego, CA

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Population Health Portal
Created in cooperation with the Federal Office of Rural Health Policy, the portal is designed to help critical access hospitals, Flex Coordinators and rural health networks navigate the journey towards improved population health.

Compare Proposals to Replace The Affordable Care Act
President Donald Trump and Republicans in Congress have committed to repealing and replacing the Affordable Care Act (ACA). How do their replacement proposals compare to the ACA? How do they compare to each other?

Healthy People 2020:  Progress Report
The 10-year initiative for tracking and reporting on the nation’s health goals gets a report on progress made toward four overarching goals:  high-quality/longer life, elimination of health disparities, healthy social and physical environments, and healthy behaviors across all life stages.  

Trends in Rural Children’s Access to Care (webinar recording)
Findings from a study based on the National Surveys of Children’s Health. For many groups of rural children, access to care rose between 2003 and 2007, but dipped slightly in 2011-2012. 

Federal Office of Rural Health Policy Data Files 
In the interest of making information on the Federal Office of Rural Health Policy's (FORHP's) rural areas more easily usable for researchers and other government agencies, FORHP has created a crosswalk of zip codes identifying the set of non-metro counties and rural census tracts that comprise rural areas as defined by FORHP.

Rural J-1 Visa Waiver
This guide has been updated with new information and frequently asked questions. Visit the guide for information on the J-1 Visa Waiver program's impact on rural health and find news, funding, and resources related to the program. 

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Funding Opportunities

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

Grants for the Benefit of Homeless Individuals  
Community organizations, local governments and Federally recognized  American Indian/Alaska Native (AI/AN) tribes are among groups eligible to apply for funds to support coordination of behavioral health and housing services.  The Substance Abuse and Mental Health Services Administration will make approximately 24 awards of up to $400,000 each for efforts that connect patients with substance abuse disorders with community systems that provide permanent housing and supportive services. 
Deadline: April 25

AARP Foundation: Identifying Evidence-Based Solutions for Vulnerable Older Adults
The AARP Foundation works to ensure that older adults have nutritious food, safe housing, a steady income, and strong and sustaining social bonds. Through the Identifying Evidence-Based Solutions for Vulnerable Older Adults grant competition, the Foundation will fund programs serving low-income and vulnerable older adults that align with the following four impact areas: food security, income, housing, and isolation. Grants will range from $50,000 to $300,00 depending on the level of evidence and maturity of the program. Eligible organizations include institutions of higher education, public entities, and nonprofit organizations.
The pre-application deadline is April 7, 2017; invited full applications will be due on May 19, 2017.

ADA Foundation: Samuel D. Harris Fund for Children’s Dental Health
The American Dental Association (ADA) Foundation works to improve the public's oral health through a variety of grants, scholarships, and awards that support oral health education programs. The Foundation’s Samuel D. Harris Fund for Children’s Dental Health provides grants of up to $5,000 to nonprofit organizations and government agencies that sponsor early childhood caries prevention education programs for caregivers of preschool-aged children in the United States and its territories. Priority will be given to programs that support intervention at or before the eruption of the primary teeth, and programs that teach caregivers how to clean infants’ teeth between 12 and 30 months of age. The application deadline is April 14, 2017. 

Substance Abuse and Mental Health Services Administration
The Grants for the Benefit of Homeless Individuals program supports the integration of behavioral health treatment and services for substance use disorders, permanent housing, and other critical services for families and individuals (including youth) experiencing homelessness. The application deadline is April 25, 2017.

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