Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  March 7, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities






QIO Webinar

VRHA and KEPRO are teaming up to offer you the Beneficiary and Family Centered Care
Quality Improvement Organization (BFCC-QIO) Program Webinar.

​KEPRO is the BFCC-QIO for over 30 states. KEPRO offers information and assistance to providers, patients, and families regarding beneficiary complaints, discharge appeals, and Immediate Advocacy. During the webinar, KEPRO representatives will present an overview of the role of the BFCC-QIO and the services provided.

Webinar is FREE and will be held April 6, 2016, 12 p.m. - 1 p.m. Click the logo to register.


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This Week...

VRHA has partnered with QualityImpact, a CMS-funded practice transformation network, to provide practices with free support and resources to aid in their transition to value-based delivery models.

A webinar will be held at noon, Tuesday March 8th to review what options are available to your organization, including analytic tools, consulting services, and quality improvement expertise.

Click here to register, or contact 336-355-8172 for questions

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Members in the News

From NRV News

When it comes to joint replacement surgery, two [VRHA members] in the New River Valley are nationally recognized for the care they provide. LewisGale Hospital Pulaski and LewisGale Hospital Montgomery both recently earned The Joint Commission’s Gold Seal of Approval® certification for knee replacement. LewisGale Hospital Montgomery also received The Gold Seal certification for hip replacement.

“This certification is a distinction that sets our hospital apart for the high-quality care we provide,” said Alan Fabian, CEO, LewisGale Hospital Montgomery. “This is just another example of our commitment to meet or exceed national quality standards.”

"Achieving this distinction means our hospital has a proven track record for providing knee replacement patients with the highest level of care,” said Derek Vance, CEO, LewisGale Hospital Pulaski. “That commitment to clinical excellence is evident in everything we do. Nothing is more important to us than ensuring our patients have the best outcomes possible.”

Read the full article.

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Virginia News

Not Straining the Budget

By Dan Heyman - Public News Service

Critics of expanding Virginia's Medicaid charge the health program for the poor is unsustainably expensive. A new analysis suggests it's not. Although the federal government will pay for almost all of covering the working poor under Medicaid, the critics say the cost will rise until the federal budget can no longer afford it.

But Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, says the financing structure put in place under the Affordable Care Act, Obamacare, has worked as planned and looks stable. In fact, he says Congress and the White House have almost never cut the program.

Thirty-one states now cover residents up to one and a third times the poverty level through Medicaid, an option under the health-care reform law. In spite of warnings that health-care reform would leave the government doing more than it can afford broadly, according to the Congressional Budget Office the law actually is working to reduce the deficit compared with what would happen under repeal.

Read the full article.

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Blooming in the Desert

By Dan Heyman - Public News Service

A provision proposed for the state budget could help finance healthy groceries for food deserts. More than 1.5 million Virginians, including nearly a half-million children, live in rural and urban areas with limited access to supermarkets. But the Virginia Grocery Investment Fund could help finance new stores in those parts of the state.

Ron Martin with the small grocery chain Grant's says financing is a huge barrier to starting a store in a food desert. He says profit margins are slim, while the equipment and inventory for even a small store can run close to $1 million. That means it's tough to expand, says Martin, even when you know there are people who want you to.

Read the full article.

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Close to Home

By Michelle Andrews - Kaiser Health News 

A few years ago, when a young woman delivered her baby at Alleghany Memorial Hospital in Sparta, North Carolina, it was in the middle of a Valentine’s Day ice storm and the mountain roads out of town were impassable. The delivery was routine, but the baby girl had trouble breathing because her lungs weren’t fully developed. Dr. Maureen Murphy, the family physician who delivered her that night, stayed in touch with the neonatal intensive care unit at Wake Forest Baptist Medical Center in Winston-Salem, a 90-minute drive away, to consult on treatment for the infant.

Things are different now. Alleghany hospital — like a growing number of rural hospitals — has shuttered its labor and delivery unit, and pregnant women have to travel either to Winston-Salem or to Galax, Virginia, about 30 minutes away by car, weather permitting.

Read the full article.

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National News

National Rural Oral Health Initiative

By Lindsey Corey - National Rural Health Association

NRHA announced that it will partner with the DentaQuest Foundation for the creation of the National Rural Oral Health Initiative. The National Rural Oral Health Initiative is the combined effort of NRHA and the DentaQuest Foundation to improve the oral health disparities in rural America through policy, communications, education and research activities. As oral health issues have long impacted those living in rural communities, the activities included in this initiative are designed to enhance access to quality oral health care.

“We want to identify strategies that engage and establish oral health care as part of primary care,” says NRHA CEO Alan Morgan. “The DentaQuest Foundation is the perfect partner for this first-ever national, rural-focused oral health initiative. The DentaQuest Foundation has a longstanding commitment to improving oral health for the rural population through fostering collaborations, raising awareness, and supporting solutions.”’

Read the full article.

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Hospitals that Thrive

From the Advisory Board Company

While many rural hospitals have struggled or closed in recent years, some have found a way to survive—or even grow—providing an economic lifeline to small towns across the country.

Beatrice Community Hospital and Health Center (BCHHC) is the second-largest employer in Beatrice. The 25-bed hospital employs 512 people, has a $28 million payroll, and brought in $100 million in revenue last year. Even as businesses have left Beatrice in recent years, BCHHC has grown, opening a new building and seeing a two-fold increase in patient visits since 2009. 

BCHHC CEO Thomas Sommers says the hospital has had to be strategic and establish a niche for itself. For instance, the average age in Beatrice is six years higher than the average age in Nebraska, so the hospital has made significant investments in treating and serving the area's aging residents. And as the town's population begins to retire, several new nursing homes have opened, with BCHHC serving as their medical hub.

Other successful rural hospitals have followed a similar model. For example, Margaret Mary Community Hospital in 6,500-resident Batesville, Indiana, has developed a rheumatology program to serve the town's aging population. Tim Putnam, Margaret Mary's CEO, has also partnered with a catch-a-ride service to provide transportation for older residents that do not have access to public transit. "We have to focus on what we do well and partner with others who can provide care that we can't," he says. 

Read the full article.

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HIT Resource Scarcity

By John Commins - Health Leaders Media

Rural physicians and hospitals have long demonstrated that they're as enthusiastic as their urban counterparts when it comes to implementing health information technology. While that's encouraging and not really surprising, a study in Health Affairs also notes that many rural providers are more likely to skip a year in declaring they've met meaningful use requirements, which puts them at a financial disadvantage, and creates a digital divide that potentially could harm patients.

The overall adoption numbers are not surprising; the fact that the overall numbers across rural and urban are similar and rural is slightly ahead. When you start digging into it is when you see these huge disparities. We also see that rural is doing well in other areas that may not have been expected. In the electronic exchanges with other providers, they are doing as well, if not slightly better. But with the electronic exchanges with patients they are still struggling.

Read the full article.

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Rural Publications

The rural hospital closure crisis: 15 key findings and trends
Many rural hospitals across the nation are faced with financial challenges, causing some to close for good. Here are 15 things to know about rural hospital closures.

Rural Medicare Advantage Plan Payment in 2015
Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant. In addition, MA plans have lower quality, on average, than plans in urban areas; therefore, rural beneficiaries could benefit from incentives for MA plans to improve quality. However, MA plans operating in many rural areas do not have the same monetary incentives to improve quality as most urban areas because they are often ineligible to receive quality-based bonus payments. 

Environmental Scan of Programs and Policies Addressing Health Disparities Among Rural Children in Poverty
Examines policies and programs aimed to address health disparities of rural children living in poverty. Provides an environmental scan of community and state-level interventions aimed to address obesity, behavioral health, oral health, pre- and postnatal care, and respiratory health.

Prediction of Financial Distress among Rural Hospitals
From 2005 through 2015, more than 100 rural hospitals have closed their doors to patients in need of inpatient services. Though a handful of these closed hospitals have since reopened, the remaining closures leave millions of rural residents at greater risk of negative health and economic hardship due to the loss of local acute care services. Policymakers, hospital managers, researchers, and rural residents are concerned and interested in identifying hospitals experiencing financial distress and forecasting potential closures. However, the ability of existing risk prediction models to forecast imminent closures is limited because a high proportion of rural hospitals fall into the highest risk category. This broad definition of financial distress makes identification of the highest risk among the “high risk” hospitals more challenging. 

Geographic Variation in Risk of Financial Distress among Rural Hospitals
Describes the geographic variation in the proportion of rural hospitals forecasted to be at high risk of distress in 2015. 

Pilot Testing a Rural Health Clinic Quality Measurement Reporting System
More than 4,000 Rural Health Clinics (RHCs) serve the primary care needs of rural communities, and are therefore an important source of primary care and other essential health services for rural residents. Unfortunately, the Rural Health Clinic Program is plagued by a lack of data on the financial, operational, and quality performance of participating clinics. In light of the significant expansion of quality performance reporting and growing use of performance-based payment approaches, it is critically important that RHCs be able to compete in this changing healthcare market. To this end, we piloted the reporting and use of a small set of primary care-relevant quality measures by a geographically diverse sample of RHCs. This policy brief reports on the results of this pilot with a focus on assessing the feasibility and utility of the reporting system and quality measures for the participating RHCs. 

Which Physician Assistant Training Programs Produce Rural PAs? A National Study
The proportion of physician assistant (PA) graduates who enter practice in rural settings has dropped over the last two decades, though PAs still continue to enter rural practice at a higher rate than primary care physicians. Between 2000 and 2012, 10% of PA training programs produced about 34% of rural PAs; those same programs produced only 14% of all the PAs graduating in the same period. This study identifies the PA training programs that produced high proportions and/or numbers of rural PAs and the program characteristics associated with that success. 

Access to Rural Home Health Services: Views from the Field
Access to home health care can be challenging for rural Medicare clients. Key informants for this study from across the U.S. detailed these obstacles, which include financial, regulatory, workforce, and geographic issues, as well as solutions that merit consideration. Rural communities, especially those served by small and non-profit home health agencies, will likely benefit from payment reforms that reward quality services while providing incentives to innovate and use best practices in home health care. 

Palliative Care in Critical Rural Settings
A case report illustrates the role that nurses and critical access hospitals play in meeting the need for high-quality palliative care in rural settings. Working together, rural nurses and their urban nursing colleagues can provide palliative care across all health care settings. 

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Mark Your Calendar

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

March 8: Transforming Care with Quality Impact - webinar
March 8: Champions 4 Children - Abingdon
March 11 & March 18Rural Health Clinic Webinar Series 
March 23 & 24: Rural Health Clinic Capstone Meeting - Blacksburg
March 28-31: National Rx Drug Abuse Summit - Atlanta, GA
April 6: BFCC-QIO Program webinar
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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Regional Blueprint for Action
Document from the Mid-Atlantic Regional Health Equity Council illustrating regional trends on health disparities and the social determinants of health.

The Health and Well-Being of Children in Rural Areas
Chartbook based on data from the latest round of the National Survey of Children's Health (NSCH). 

NOSORH Grant Writing Institute: Rural Health Grant Writing Specialist Training
A four-month training series designed to help rural health professionals build grant writing and grant management skills.
Application Deadline: Apr 7, 2016 

Medicare Learning Network e-Newsletter

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Funding Opportunities

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

National Health Service Corps Loan Repayment Program
Applications due April 5. 
Primary care medical, dental and mental/behavioral health clinicians can get up to $50,000 to repay their health profession student loans in exchange for a two-year commitment to work at an approved NHSC site in a high-need, underserved area. In an effort to better integrate mental and behavioral health with primary care, the National Health Service Corps added two new changes to the Application and Program Guidance for the 2016 Loan Repayment Program application. Mental and behavioral health providers must now spend at least 32 hours each week providing patient care at approved health care sites – the same requirement for NHSC medical and dental providers. Previously, the requirement was 21 hours. Additionally, mental and behavioral health providers must work in a community-based setting. If the provider works at a private practice, the practice must be affiliated with a community-based facility that provides comprehensive health care services, including mental health.  Approved NHSC sites are located across the U.S., in both urban and rural areas, and can be found using the NHSC Jobs Center.

Migrant Health Scholarship
Offers scholarships to individuals pursuing or continuing their career in the migrant health field and employees at a Community/Migrant Health Center.
Application Deadline: Mar 18, 2016
Sponsor: National Center for Farmworker Health 

National Safety Net Advancement Center Grant Awards
This solicitation seeks proposals from safety net organizations seeking to overcome implementation challenges related to payment reform.
Application Deadline: Apr 1, 2016
Sponsor: National Safety Net Advancement Center 

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