Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  February 29, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter now available




VRHA Milestone!

The Virginia Rural Health Association has officially reached a new membership high of over 1,000 rural health stakeholders!
This includes:

  • 39 large organizations (10 people each)
  • 22 small organizations (5 people each)
  • 109 individuals
  • 495 students

Thanks to the Board of Directors, our student leaders, and everyone else who has promoted the benefits of VRHA for all of your hard work!

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Hotel Deal

Are you considering attending the March 23 & 24 Virginia Rural Health Clinic meeting? We have a great deal for you!  We have secured rooms at for the Inn at Virginia Tech for only $100/night.  That's 35% off their regular room rate.

Click here for hotel reservations or here for more event information.

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Budget Policy Choices

Virginia’s House of Delegates and Senate have unveiled their 2016 budgets, and we’re disappointed (but not surprised) that healthcare coverage expansion is not part of either one. The General Assembly is still convinced that charity care is healthcare coverage, putting a strain on the state’s hospitals and keeping our working poor friends and neighbors from access to quality, affordable healthcare.

Our friends at The Commonwealth Institute for Fiscal Analysis put out a report on February 24 with a side by side comparison of the three budgets submitted by Gov. Terry McAuliffe, the House of Delegate, and the Senate.

We’re counting on you to contact your Virginia legislators to continue to press them to make healthcare access a reality for all Virginians. The Commonwealth Institute has an analysis that can tell you how many people in your House and Senate district are in the coverage gap. We encourage you to use those numbers when you call or email your representatives to tell them how many of their constituents they’re locking out of quality, affordable care.

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Virginia News

Spend More, Do Less

By Massey Whorley - The Commonwealth Insitute

Governor McAuliffe’s proposal to close the coverage gap in his two-year budget could bring affordable health care to 400,000 Virginians who don’t have insurance. And it would save the state $157 million to invest in other priorities by using $3 billion in federal funds for comprehensive coverage rather than state dollars for a patchwork of safety net programs.

But opponents in the House and Senate have made clear they intend to block the governor’s common-sense plan. Instead, they will likely require the state to spend additional taxpayer dollars just to maintain the current level of services.

For example, there’s a budget amendment before the House Appropriations Committee to put $85 million in state funds back into Medicaid. That wouldn’t be necessary if lawmakers closed the coverage gap. There’s another amendment to devote $41 million in state funds for mental health care. Again, that wouldn’t be necessary if lawmakers closed the coverage gap. There’s one more for $35 million to cover inmates’ hospital costs. And that wouldn’t be necessary either if lawmakers closed the gap. 

Read the full article and related stories from the Public News Service, Virginia Interfaith Center for Public Policy and Richmond Times-Dispatch.

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Mental Health Do-Over


Virginia should dismantle its mental-health system and replace it with one that serves Virginians who are sick rather than the bureaucrats who should be helping them. From 2010 to 2014, I served as Virginia’s inspector general for behavioral health and developmental services, which required me to cast a critical eye on the state’s mental-health services and recommend changes to improve the commonwealth’s system of care. I found a complex, dysfunctional and ineffective bureaucracy that was system-centered instead of person-centered. I found an ineffective bureaucracy that privileged the status quo over the people it should be serving. 

The state’s bureaucracy, with a centralized state Department of Behavioral Health and Developmental Services overseeing local community services boards, has resulted in an unaccountable but politically powerful state and local partnership that focuses on self-perpetuation instead of the people it is charged to serve. 

Read the full commentary.

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Close to Home

By Tim Marema - Daily Yonder

Keith Gabbard is the first to admit that there’s a lot his rural Kentucky county doesn’t have — a hospital, college, railroad, interstate, or even a four-lane highway, for instance. But Gabbard says instead of focusing on what’s missing, he’d like to concentrate on what Jackson County does have: blisteringly fast Internet service that is the envy of its urban neighbors.

Gabbard is CEO and general manager of PRTC, a telephone cooperative that serves Jackson and Owsley counties in southeast Kentucky. Jackson and Owsley are not the first counties that come to mind when you think of ubiquitous access to fiber-optic cable – the fastest conduit for digital communication. The counties are part of the Kentucky Fifth District, the most rural congressional district in the United States. They are also among the poorest in the United States. About a third of all residents in Jackson and Owsley live below the poverty line. Median household incomes are about half the national rate.

Gabbard and others involved in deploying and using the county’s network hope the new fiber system can be part of improving the economy and quality of life in their service area.

Read the full article and related story about funding projects in other states.

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National News

New CAH Guidance

The Centers for Medicare & Medicaid Services (CMS) released a recertification guidance and checklist to state survey agency directors indicating that states may immediately use alternative ways to document that a critical access hospital (CAH) is a necessary provider. This new guidance acts on the concerns expressed to the agency and provides additional flexibility to state survey agencies, which is critical to helping CAHs that rightfully obtained necessary provider status prior to 2006 from losing their CAH designation.
The new guidance, recertification checklist, and case study, allow state survey agencies to consider alternative methods of documentation for necessary provider CAHs. Specifically, this guidance indicates that a necessary provider designation letter issued by the state prior to Jan. 1, 2006 is only one example of acceptable documentation. CMS states that the regional offices also may consider other documentation provided by the state that demonstrates that the CAH received the necessary provider designation prior to Jan. 1, 2006.

Note that VRHA's own Page Memorial Hospital is the facility used for the case study. Congratulations PMH on maintaining your CAH status!

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Hospitals in Critical Condition

By John Commins - HealthLeaders Media

You've probably read the alarming report from iVantage Analytics showing that 673 rural hospitals—one out of three—are under financial duress, and that 210 are at high risk of closing.
The methodology iVantage used to make this dire prediction looked at about 70 metrics such as market position, balance sheet, costs, charges, and outcomes from the more than 66 rural hospitals that have closed since 2010 and applied those same metrics to rural hospitals that remain operational.

"Statistically, they correlated. As we looked at those 70 indicators, we found 210 hospitals that were highly correlated with hospitals that had closed and another 453 that were strongly correlated with the hospitals that had closed," says Michael Topchik, senior vice president at Portland, ME-based iVantage.

Alan Morgan, CEO of the National Rural Health Association, which partnered in the iVantage study, says the findings are troubling, but not surprising to anyone paying attention.

Read the full article.

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Rural or Urban? 

By Lisa Schencker - Modern Healthcare

Some believe a federal appeals court decision over hospital classifications could lead to millions of dollars in savings for hospitals across the country.

The 2nd U.S. Circuit Court of Appeals decided Thursday to invalidate a Medicare regulation that says certain hospitals can't be classified as both rural and urban. The decision applies only to hospitals within that circuit. But some hope that decision, combined with an earlier similar one in a different circuit, will inspire HHS to change the regulation across the country.

“It's not good to have the Medicare program inconsistent across the country,” said Joseph Glazer, the New Jersey attorney for the plaintiff, 252-bed Lawrence & Memorial Hospital in New London, Conn. The change would have significant nationwide impact, he said. 

Read the full article.

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Emergency Medicine

By Andy Kerstetter - idaho Mountain Express

Medical students at the University of Washington now have another opportunity for hands-on learning in the medical field in the Wood River Valley, thanks to St. Luke’s Wood River’s new emergency medicine residency program.     

Starting in December, the university began sending students in their last year at its four-year emergency medicine residency program to St. Luke’s for a month each to learn about emergency medicine in a rural setting.     

The university has sent medical students to the hospital for residencies in the past, but those have usually been for general or family medicine. When it comes to emergency medicine, students can only be trained by certified emergency physicians—and St. Luke’s has the perfect opportunity since all of its emergency staff members are certified emergency physicians.

Read the full article.

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Mark Your Calendar

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

March 11 & March 18Rural Health Clinic Webinar Series 
March 8: Transforming Care with Quality Impact - webinar
March 23 & 24: Rural Health Clinic Capstone Meeting - Blacksburg
March 28-31: National Rx Drug Abuse Summit - Atlanta, GA
April 6-8: National Health Outreach Conference - Roanoke
April 10-12: Mid Atlantic Telehealth Resource Center Annual Summit - Cambridge, MD
April 25-26: National Reduce Tobacco Use Conference - Washington, DC

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Population Health Portal
The Population Health Portal is designed to help critical access hospitals (CAHs), Flex Coordinators and rural health networks navigate the journey towards improved population health. 

Required Billing Updates for Rural Health Clinics 
Effective April 1, 2016, RHCs, including RHCs exempt from electronic reporting under Section 424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. Payment for RHC services will continue to be made under the All-Inclusive Rate (AIR) system when all of the program requirements are met. There is no change to the AIR system and payment methodology, including the 'carve out' methodology for coinsurance calculation, due to this reporting requirement. Make sure that your billing staffs are aware of these RHC-related changes for 2016.

4 Things to Include in Your Social Media Policy
A negative review. A bad comment. An inappropriate post. These are all reasons why many healthcare organizations are reluctant to become too active on social media. However, since social media is such a large part of people's everyday lives, your healthcare facility can't afford not to be active. That's why it's important to have a comprehensive social media policy.

Conducting Rural Health Research, Needs Assessment, and Program Evaluation
This guide includes identifies the similarities and differences among rural health research, assessment, and evaluation. It also discusses common methods, provides contacts, addresses the importance of community-based participatory research in rural communities, looks at CHNA requirements, and examines the importance of building a rural evidence-base. Includes new questions related to strategies to share rural health research results.

SAMHSA Opioid Overdose Prevention Toolkit
Includes facts for community members, essential steps for first responders, information for prescribers, safety advice for patients and family members, and resources for overdose survivors and their families.

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Funding Opportunities

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

Addressing Disparities Research Grants
Offers funding to research the comparative effectiveness of enhanced interventions that reduce or eliminate disparities in health and healthcare. Research that focuses on residents of rural areas is listed as a funding priority.
Letter of Intent (Required): Mar 2, 2016
Application Deadline: Jun 6, 2016 

Rural Medical Educators Student Scholarship
Offers funding to medical students to attend the Rural Medical Educators Conference.
Application Deadline: First-come, first-serve basis until all funds are committed. Event happens May 10, 2016 

Telehealth Network Grant Program (TNGP)
Funding to demonstrate how telehealth programs and networks can improve access to quality health care services in rural, frontier and underserved communities.
Application Deadline: Apr 8, 2016

Newman's Own Award
Offers grants to organizations working to improve the quality of life for military members and their families, including job training, housing, caregiver support, and mental health programs.
Application Deadline: Apr 28, 2016

Hillman Innovations in Care Program
Provides funds for nurse-driven models of care focused on patient- and family-centered approaches that challenge conventional strategies, improve health outcomes, lower costs, and enhance patient and family caregiver experience.
Application Deadline: Mar 21, 2016

National Safety Net Advancement Center: Accelerating Value-Based Payment and Care Delivery in the Health Care Safety Net
Application Deadline: April 1, 2016
The National Safety Net Advancement Center, funded by the Robert Wood Johnson Foundation, aims to transform the ability of safety net organizations to respond to payment and health care delivery reform efforts. The current Value-Based Payment and Care Delivery in the Health Care Safety Net call for proposals provides grants and scholarships to U.S. safety net organizations.

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Virginia Rural Health Association
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Blacksburg, VA 24060

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