Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue July 20, 2015

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


July Newsletter available




50 Years of CHCs

The 50th Anniversary of the Health Center Movement:  
Community Health Centers started out as a small pilot program. Fifty years later, health centers have not just survived, but have expanded into the largest system of primary care that serves 23 million people. Why? Because they are good at what they do.

Come learn about the history of the CHC program, what’s available in Virginia, and how people can connect with their local CHC with Nancy Stern - Eastern Shore Rural Health System, Inc. & Rod Manifold - Central Virginia Health Services
GIF logo
VRHA Annual Conference
October 13 & 14
Staunton, VA

Click the conference logo for event details.

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Virginia News

Next Steps

By Tammie Smith - Richmond Times Dispatch

Faith leaders gathered in Richmond to press the case that the provision of health care for all Americans is a moral imperative. The Supreme Court ruling that upheld subsidies for people buying health insurance on state- and federally run insurance exchanges was lauded as a victory for millions of low- and middle-income Americans.

But millions more, some of the poorest, are still without — falling in a coverage gap in states like Virginia that did not expand Medicaid to provide health coverage for more of the poor as the Affordable Care Act intended.

Read the full article and related editorial.

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Your Community's Health

From the Virginia Health Care Foundation

In December of 2014, the  Virginia Center for Health Innovation was awarded a State Innovation Models (SIM) design grant from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS). The creation of Accountable Care Communities (ACCs) in Virginia is a core strategy of Virginia's SIM Design Award. ACCs are "coalitions of the willing," made up of multiple public and private stakeholders who commit to working collaboratively to provide better care and obtain better health at a lower cost in their regions, and to share the responsibility for the health of the community.
You can participate in these important groups. Join the one in your region, participate in an upcoming webinar, or sign up to stay informed on their progress, by visiting the Center's website.

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Close to Home

By Scott Hensley - NPR

Researchers at the American Cancer Society analyzed colorectal cancer death rates by county and identified three geographic hot spots: the Lower Mississippi Delta, west central Appalachia, and a swath of counties in eastern Virginia and North Carolina.

"There are areas in the South that pop out with particularly high rates," epidemiologist Rebecca Siegel tells Shots. While the colorectal cancer death rate has declined nationally since 1970, the rates in the hot spots were either stagnant or rose, she says.

Poverty, a lack of health insurance and low levels of education and health literacy are factors that may help explain what's happening in the hot spots, Siegel says. People in rural area may also have more difficulty getting screening and treatment.

Read the full article.

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National News

2 Midnight Rule Modification

By Virgil Dickson - Modern Healthcare

The CMS plans to soften but keep the controversial "two-midnight" rule governing short hospital stays in spite of aggressive calls from providers and policy experts to abandon the policy.

In a proposed payment rule posted Wednesday, the Obama administration said it plans to allow physicians to exercise judgment to admit patients for short hospital stays on a case-by-case basis. The CMS also said it would remove oversight of those decisions from its administrative contractors and instead ask quality improvement organizations to enforce the policy. Recovery audit contractors, meanwhile, would be directed to focus only on hospitals with unusually high rates of denied claims.  

Read the full article.

NRHA is pleased that CMS added additional flexibility into the “two-midnight” rule for payments for short hospital stays. However, we are dismayed CMS continues to include a rule that does not focus on the clinical factors involved in providing for the most vulnerable patients, while extending the length of time until a hospital is paid for services already provided. NRHA has called for eliminating this imprudent rule since it was introduced and will continue to fight for its elimination.

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Physician Fee Schedule Update 

By the Center for Medicare & Medicaid Services

On July 8, CMS released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The proposal includes a number of provisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes. 

The rel
ease of the rule triggers a 60-day comment period, during which time CMS welcomes the input of stakeholders and the public.  A final rule will be published this fall.

For More Information:Proposed Rule & Fact Sheet

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Rural Mortality Increases

By Jonathan Baker - HPPR

A study by Texas A&M University has found that rural living can be deadly. A lack of emergency services in outlying areas is costing lives, notes The Rural Blog. The study found that, during an emergency, those living more than 30 minutes from an emergency health-care facility have a 46 percent mortality rate, compared to only 21 percent for those living within 30 minutes of a hospital.

As health care facilities continue to consolidate and the population at large grows older and more infirm by the year, the problem is expected to worsen. In the last decade fifty rural American hospitals have closed, and 283 more are at risk of closure. Researchers determined that access to healthcare was the number one concern of rural residents.

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Rural Publications

Widening Rural-Urban Disparities in Youth Suicides
Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.

The Rural Obstetric Workforce in US Hospitals
Individual hospitals working in isolation may struggle to address staffing challenges. Federal and state policy makers, regional collaboratives, and health care delivery systems can facilitate solutions through programs such as telehealth, simulation training, and interprofessional education.

A Comparison of Closed Rural Hospitals and Perceived Impact
From 2010 through 2014, 47 rural hospitals ceased providing inpatient services in 23 states across the country (“closed”). Among the 47 closed hospitals, 26 hospitals no longer provide any health care services (“abandoned”), and 21 continue to provide a mix of health services but no inpatient care (“converted”).

These closures have affected approximately 800,000 people in the markets with abandoned hospitals and 700,000 people in the markets with converted hospitals. This policy brief compares selected characteristics of abandoned rural hospitals and their markets to those of converted rural hospitals.

Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs with Rural Presence
In this policy brief, we present the findings of a survey of 27 rural ACOs focusing on characteristics important to their formation and operation. We find that a majority of responding ACOs were formed from pre-existing integrated delivery systems and had physician and hospital participants with prior risk-sharing and quality-based payment experience. In addition, physician groups played a leading role in the formation and management of the ACOs. 

Minimum-Distance Requirements Could Harm High-Performing Critical-Access Hospitals And Rural Communities
Our study found that critical-access hospitals located within fifteen miles of another hospital generally are larger, provide better quality, and are financially stronger compared to critical-access hospitals located farther from another hospital. Returning to the PPS would have considerable negative impacts on critical-access hospitals that are located near another hospital. We conclude that establishing a minimum-distance requirement would generate modest cost savings for Medicare but would likely be disruptive to the communities that depend on these hospitals for their health care. 

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Mark Your Calendar

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

August 24-27: Arthritis, AgrAbility, and Rural Health Conference - Knoxville, TN
September 29-30: Rural Health Clinic Conference - Kansas City, MO
September 30-October 2: Critical Access Hospital Conference - Kansas City, MO
October 13-14: VRHA Annual Conference - Staunton
October 15: REVIVE! Training of Trainers - Staunton

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Military Culture
This website was designed by Military Culture experts working as part of a DoD/VA collaborative effort to help healthcare professionals become more culturally aware by providing education, tools and resources for their clinical practice    

CMS Medicare Learning Network newsletters:

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Funding Opportunities

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

American Association on Health and Disability  
Deadline: 11/16/2015
Funding opportunities to promote health and wellness in people with disabilities and to identify effective intervention strategies that reduce health disparities. 

AMA Foundation: Healthy Living Grant Program
The Healthy Living Grant Program, an initiative of the AMA Foundation, supports health education programs to develop school and community-based solutions to behavioral health challenges. In 2015, grants will be awarded in the following categories: The Youth-Focused Prescription Medication Safety category supports projects that provide awareness programs about the dangers of prescription drug abuse for at-risk children and youth ages two to 21. The Cancer Prevention Education category supports projects that focus on awareness and education for underserved populations about preventing a specific type of cancer. Funded projects in both categories must involve a partnership with a medical organization. The application deadline is September 11, 2015.

Bama Works Fund of Dave Matthews Band in CACF      
Deadline: 08/1/2015
Funding for charitable programs in the Charlottesville area such as disadvantaged youth, needs of the disabled, protection of the environment, and the arts and humanities.


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