Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  June 20, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities

The VDH Office of Minority Health and Health Equity is now the Office of Health Equity.  
Check it out!




Members in the News

By  - WHSV

In Woodstock, [VRHA member] Shenandoah Memorial Hospital gave tours to the public of its new 45,000 square foot ER. This emergency room replaces the existing one, and it almost doubles the hospital's emergency room capacity and adds actual rooms, whereas before there were just curtains separating patients. 

This new building also adds physicians' offices on the top two floors, elevating the level of care the hospital can provide.

Read the full article.

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More Members in the News

By Michael Ollave - PBS Newshour

[VRHA member] Edward Via College of Osteopathic Medicine (VCOM), a nonprofit, opened its first campus in 2002 on the campus of Virginia Tech University, in southwestern Virginia. At the time, all three of the state’s medical schools were in the eastern part of the state. State officials and those at Virginia Tech concluded that the VCOM campus would be the best way to address the severe doctor shortage in that part of the state.

The nation is projected to face a shortage of as many as 94,700 physicians by the year 2025, according to the most recent analysis by the Association of American Medical Colleges (AAMC), which represents 145 American medical schools and 400 teaching hospitals and health systems. And in 2014, providing the same amount of medical care to underserved areas would have required as many as 96,200 more physicians, according to the AAMC.

Read the full article.

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Virginia News

Lee Hospital Delays

By Allie Hinds - WJHL

Mountain States Health Alliance says it is not to blame for delays in re-opening a Southwest Virginia Hospital. At a packed meeting Wednesday, people in Lee County, Virginia said their community is in desperate need of a hospital. Right now, thousands of people who live in the county have to travel at least 21 miles for the nearest emergency care.

Some at the meeting blamed the delay in reopening the hospital on the proposed merger between Mountain States and Wellmont. Some people at the meeting last night asked the Southwest Virginia Health Authority board to require the merged systems to reopen the Lee County Hospital. 

Mountain States CEO Alan Levine said the delay has nothing to do with the merger. Levine said without the savings the merger will bring, Mountain States won’t have the resources to guarantee anything in Lee County.

Read the full article.

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Saltville Recovery Program

By Linda Burchette - SWVA Today

Suboxone, the brand name for a combination of buprenorphine and naloxone used in the treatment of opioid addiction, is a term many in Saltville are just learning. It is a new tool in the war on drug abuse in the community. The abuse of drugs, particularly opioids such as heroin and prescription drugs including oxycodone and hydrocodone, has become an epidemic in Saltville as well as the rest of the country, and local residents and officials want to do something about it.

A group of citizens and law enforcement officials met last month to begin a discussion on options and [VRHA member] Southwest Virginia Community Health Systems that leases the Saltville Medical Center secured a grant in March to establish a medication-assisted treatment program.

Read the full article.

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Reimbursement Fight

Virginia’s two U.S. senators are pushing legislation to help rural hospitals across the commonwealth get the same reimbursement rate for Medicare as their urban counterparts. Many rural hospitals are facing extinction, that’s in part because of the way they’re paid by the federal government for the Medicare patients they serve.

The legislation is called the Fair Medicare Hospital Payments Act of 2016. It changes the index for payments to hospitals from a regional one to a national one. Currently hospitals get federal dollars based on a wage index tied to the local economy, but the senators want to set a national index that would benefit rural hospitals. Warner says rural hospitals are currently losing out on millions of dollars that they need to survive.

Read the full article.

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National News

MedPAC Report

By Diane Camus - National Rural Health Association

The Medicare Payment Advisory Commission (MedPAC) released their June report to Congress, which includes a chapter discussion on preserving access to emergency care in rural America. The report presents two options for future care in rural – a 24/7 emergency department and primary care outpatient services and a primary care clinic (12 hours/day) and ambulance (24/7).  Both of these programs would be optional.

The National Rural Health Association is pleased that the Commission is recognizing that access to care in rural communities is an ever increasing problem. However, NRHA is concerned that MedPAC failed to understand why rural hospitals are closing and without that understanding it does nothing to stop the hospital closures that are caused by the plethora of Medicare cuts. Indeed, in the March 2016 MedPAC report it stated “average Medicare margins are negative, and under current law they are expected to decline in 2016.” Twelve rural hospitals have already closed this year with a total of 75 rural hospitals closing since 2010, and the rate of these closures is increasing. Even more concerning is that 673 rural hospitals are at risk of closure, meaning sustained Medicare cuts threaten the financial viability of 1 in 3 rural hospitals.

While NRHA is supportive of the concepts of creating a new provider type for rural communities (for example, the Community Outpatient Hospital created in the Save Rural Hospitals Act, H.R. 3225) we are concerned that MedPAC does not appear to be focused on the important issue of sustainability of a new provider type. Any new model must ensure that the grants are sufficient to keep these facilities open in the long run. MedPAC’s recommendations appeared to focus on cost neutrality and making the grants just a new way to allocate the same money. However, by MedPACs own admission, this money has not been enough to keep rural hospitals from closing.

Continued cuts in hospital payments have taken their toll on rural hospitals. Already, medical deserts are appearing across rural America, leaving many of our nation’s most vulnerable populations without timely access to care. NRHA will continue to work with Congress and the Administration to ensure health care in rural America is maintained.

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Income Inequality

From USDA Secretary Tom Vilsack 

Rural child poverty fell by 3 percentage points from 2012 to 2014. Over the past seven years, USDA and the Obama Administration have taken action to address the root causes and reduce the devastating effects of rural child poverty.  As a record streak of private sector job creation has cut nationwide unemployment in half, to 5 percent, average incomes for rural and urban families alike climbed nearly 6 percent in the last two years of data, returning to 2003 levels.  While we have made important progress in increasing incomes and reducing the rural child poverty rate, it remains unacceptable that 1.5 million children in rural America – 23.7 percent of all rural youth – live in poverty.

No child in this country should grow up in poverty.  And as a new analysis by USDA’s Economic Research Service (ERS) makes clear, to end that injustice we must do more to tackle growing income inequality.  The study, released today, found that rising income inequality explains an overwhelming 93 percent of the increase in rural child poverty between 2003 and 2014.  As the report notes, income inequality was considerably higher in 2014 than in 2003 in both urban and rural areas.  Over the past seven years, USDA and the Obama Administration’s work to bring economic opportunity to rural America has produced concrete results: rural areas are seeing income growth; two-thirds of rural communities have demonstrated job growth; and for the first time in years, rural areas are gaining population rather than losing residents.  But this new research on the pervasive effects of income inequality underscores that broader Administration priorities, like raising the minimum wage, must be part of any comprehensive approach to rural poverty.

Read the full article and a related study from the University of Alabama at Birmingham.

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Insurance Options Disappearing

By Emily Rappleye - Becker's Hospital Review

Data from the Kaiser Family Foundation shows more than 650 counties will have just one insurer on the exchanges next year, and 70 percent of these counties have mostly rural populations, according to the report. This number is up significantly from 225 counties with just one insurer on the exchanges in 2016, and it could continue to grow, according to the report. The latest figures won't be available until all state filings have been made public in September.

Alaska and Alabama are the hardest hit states, in which no county will have more than one insurer on the exchanges. Other states with fewer options for rural residents include Kentucky, Tennessee, Mississippi, Arizona and Oklahoma, according to the report. Data from Inovalon cited in the report indicates insurers may be rapidly pulling out of the exchanges for rural areas because costs are higher there.

Read the full article.

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Different, Not Less

By Betsey Russell - Daily Yonder

Philanthropies that aren’t investing in rural communities are missing big opportunities, says Justin Maxson, executive director of the Mary Reynolds Babcock Foundation in North Carolina. Whether they are trying to win statewide policy victories, serve individuals who need help the most, or address issues like climate change or economic renewal, philanthropies won’t make as much progress if they don’t include rural communities in their programs, Maxson says.

But that’s apparently not what has happened in the recent past. A U.S. Department of Agriculture study released last year showed that rural areas, while they were home to about 19 percent of the U.S. population,  received only 6 to 7 percent of private foundation grants awarded from 2005 to 2010. Agriculture Secretary Tom Vilsack called the disparity “tragic,” especially in light of earlier conversations the administration has had with foundation leaders about increasing philanthropy in rural areas.

Read the full article.

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Mark Your Calendar

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

June 15: Rural Neonatal Outreach​ - webinar
June 16: Provider Cost Containment in a Rural Healthcare Environment​  - webinar
June 22: CDC Guideline for Prescribing Opioids for Chronic Pain​ - webinar
July 13-15: Rural Quality and Clinical Conference​ - Oakland, CA
July 20: From Impact to Implementation: Trauma Informed Care and the Health Care Safety Net​ - Richmond 
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO

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Webinar Recording Available: Exploring Rural and Urban Mortality Differences
Alana Knudson, PhD, from the North Dakota and NORC Rural Health Reform Policy Research Center, reviews findings from the recently released study, Exploring Rural and Urban Mortality Differences. This study examines the impact of rurality on mortality and explores regional differences in mortality rates.

For more information, read more about the Exploring Rural and Urban Mortality Differences study

Preventing the Spread of HIV
Last year, an HIV outbreak in rural Indiana brought national attention.  This year, the Centers for Disease Control (CDC) has identified suburban and rural areas of the South as having “a greater number of new HIV diagnoses than anywhere else in the country.”  In addition to increased funding, the CDC is asking that health care providers become familiar with Pre-exposure prophylaxis (PrEP), a new HIV prevention method in which people who do not have HIV, take a pill daily to reduce their risk of becoming infected.  Clinicians can prescribe the medication, counsel patients on PrEP and other HIV prevention methods, and support and monitor patients taking PrEP.  Brochures, fact sheets and other resources are available to help patients understand the risks of infection and benefits of PrEP.  

Comprehensive Primary Care Plus – A Rural Commentary
Comprehensive Primary Care Plus (CPC+)  is a new initiative from the Center for Medicare & Medicaid Innovation (CMMI) designed change the payment structure to one that rewards better care, smarter spending, and healthier people.  Later this summer, CMS will begin accepting applications from providers who wish to participate in the five-year initiative, set to start in 2017. This brief from FORHP-funded Rural Health Value looks at the CPC+ program through a rural lens and helps stakeholders understand the importance and the challenges of this payment model for rural primary care practices – particularly those interested in developing population health capacity and being rewarded for population health investments.

Faith Leaders Toolkit 
Trusted faith leaders are in a unique and important position to help people at risk for type 2 diabetes and with diabetes. And the new Faith Leaders Toolkit from the National Diabetes Education Program can help. The toolkit makes it easy for you to begin new programs and enhance existing programs that motivate your members to improve their health.

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Funding Opportunities

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

Community Foundation - Central Blue Ridge
Multiple opportunities for nonprofit organizations serving the independent cities of Staunton and Waynesboro, and the counties of Augusta, Nelson, and Highland to submit proposals for support of their general operations, specific programs, and capital projects.
Deadline: varies by project type

Community Foundation of the New River Valley
Responsive grants are offered semi-annually with one cycle in the Spring and Fall of each year. The Responsive Grant Program is tailored to make a positive impact in the community by responding to ongoing or emergent community needs as recognized by the area non-profits serving those needs directly. 
Deadline: August 5th

Programs to Reduce Obesity in High Obesity Areas to Boost Prevention
Awards funds to land grant colleges and universities for projects that will work to improve physical activity and nutrition; reduce obesity; and prevent and control diabetes, heart disease, and stroke in areas where adult obesity rates are high.
Geographic coverage: Available in 17 states - including Virginia
Application Deadline: Aug 2, 2016 

Kent Richard Hofmann Foundation
The Kent Richard Hofmann Foundation is dedicated to the fight against HIV and AIDS. Grant requests from throughout the United States are considered, with particular interest in smaller communities and rural areas. The Foundation supports community-based nonprofit organizations that focus on HIV/AIDS care and direct services, education, or research. Grants are provided to developing or established programs, with emphasis on those that provide direct benefit to clients or target audiences. Requests are reviewed two times per year. The upcoming deadline for letters of inquiry is September 2, 2016; invited grant applications will be due September 23, 2016.

Susan Harwood Training Grant Program
Provides grants to fund education and training programs or educational material development for workers and employers to help them recognize workplace safety and health hazards, implement injury prevention measures, and inform them of their rights and responsibilities.
Application Deadline: Jun 28, 2016 

Rural Broadband Access Loan and Loan Guarantee Program
This program furnishes loans and loan guarantees to provide funds for the construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas.
Application Deadline: Jul 7, 2016 

Transforming Clinical Practices Initiative (TCPI) Support and Alignment Networks (SAN) 2.0
Awards funding to support networks to provide technical assistance in order to leverage primary and specialist care transformation work and learning in the field. The focus will be on preparation of clinical practices for the accelerated adoption of Alternative Payment Models (APMs) on a large scale and at low cost before 2019.
Letter of Intent (Optional): Jul 1, 2016
Application Deadline: Jul 11, 2016 

Funders' Network for Smart Growth and Livable Communities: Partners for Places
Partners for Places, an initiative of the Funders' Network for Smart Growth and Livable Communities, is a matching grant program that creates opportunities for cities and counties in the United States and Canada to improve communities by building partnerships between local government sustainability offices and place-based foundations. Through the program, funders invest in local projects to promote a healthy environment, a strong economy, and well-being of all residents. For Round Nine, grants will range between $25,000 and $75,000 for one-year projects, or $50,000 and $150,000 for two-year projects, with a 1:1 match required by one or more local foundations. The proposal must be submitted by a team of at least two partners consisting of the sustainability director of a city or a county, and the local, place-based foundation(s).
The application deadline is July 25, 2016.

Open Meadows Foundation
The Open Meadows Foundation is dedicated to funding projects that are led by and benefit women and girls, particularly those from vulnerable communities in the U.S. and worldwide. The Foundation supports projects that are designed and implemented by women and girls, reflect the diversity of the community served by the project, promote building community power, and encourage racial, gender, and economic justice. Priority is given to organizations that have limited financial access or have encountered obstacles in their search for funding. The Foundation provides grants of up to $2,000 to cover start-up expenses or to support ongoing projects. (The Foundation also administers several special funds that are targeted to specific groups or activities.) Proposals for all of the Foundation's grant opportunities may be submitted between July 1 and August 15, 2016.

Connect 4 Mental Health: Community Innovation Awards
Connect 4 Mental Health (C4MH) is a nationwide initiative that calls for communities to prioritize serious mental illness. C4MH's Community Innovation Awards program is designed to recognize local organizations across the country that are implementing approaches that support individuals living with serious mental illness and their families. C4MH will issue four awards to U.S. community programs exhibiting innovative work in the following four pillars: Early Intervention, Creative Use of Technology, Continuity of Care, and Service Integration. Each winner will receive a $10,000 award to support program efforts in their communities.
The application deadline is July 22, 2016. 

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