VRHA Weekly Update
In this Issue March 31 - April 6, 2014

Virginia News National News Mark your calendar
Funding Opportunities


Virginia Oral Health Coalition

March Newsletter




Make Your Voice Heard!

the Senate Finance Committee will have a public comment period during its next meeting at the General Assembly building on Tuesday, April 1 at 2:00pm This meeting is a big opportunity for VRHA members and fellow health care advocates to demonstrate our unwavering support for closing the coverage gap without delay.

Our goal is to show our strength to legislators, the media, and the public by filling the room with health care supporters. Please attend this meeting and be prepared to speak briefly on why closing the coverage gap is so important to you and the constituency you represent. 

Click here to review talking points on this topic. Unable to attend in person? Contact your GA member.

Back to the top

Members in the News

By Nadine Maeser - WDBJ7

About 7,000 uninsured people are living in Rockbridge and Alleghany counties and for more than a decade, they've depended on the free health clinic in the area. [VRHA member] Rockbridge Area Free Clinic is no longer open.

The free clinic reopened as a federally qualified health clinic, thanks to a grant. This means the clinic will stay where it is, but it will offer new and better services at a minimal cost to patients. It’s a major project in the making inside the walls of the Rockbridge Area Health Center.

"Obviously, at this point, we are in the middle of construction so we're adding a bunch of things," said development director Katy Datz.

Now known as the Rockbridge Area Health Clinic, the new facility will offer a medical lab, dental lab and new technology. It will also have four new exam rooms to increase the services they provide. Datz said the goal is to double the number of patients within the first year its open.

Read the full article.

Back to the top

Deadline Approaching

REMINDER: VRHA is pleased to offer a unique group purchasing opportunity for ICD-10 training.  The Association of Rural Health Professional Coders will allow us to purchase access to their full ICD-10 e-learning library for only $100/user.  Since the 7 training modules are typically $150-$200 each, this is a tremendous savings.  Five of them are approved by AAPC and AHIMA and users can earn up to 20 CEUs recognized by both companies.  Since ICD-10 begins October 1, the timing is perfect.

Click here to review the training modules available.

In order to receive the discount, VRHA will need to guarantee that we will purchase at least 100 user keys to the library.  This offer is not exclusive to VRHA members, or even people in Virginia, so feel free to share with your colleagues.

To order user keys your organization needs, please complete this form. VRHA will take potential orders until April 1st.

Contact Beth O'Connor (540-231-7923) with any questions you may have.

Back to the top

Virginia News

Progress Within Virginia's Grasp

By James A. Hartley - Roanoke Times

The significance of the decision currently facing our representatives in the General Assembly regarding the expansion of Medicaid cannot be overstated, not only for hundreds of thousands of uninsured Virginians, but the southwest region as a whole.

As the chairman of the Carilion Clinic board of directors, I am seeing firsthand the significant challenges that providing care to the uninsured presents, both to our health care system and to our regional economy.

The challenges facing hospitals, physicians and the health care system are many. First and foremost are the various reductions in payments for services to beneficiaries of the federal Medicaid program that are contained in the Affordable Care Act.

Read the full editorial and related editorials by US Senator Tim Kaine and Virginia Senator John Edwards.

Back to the top

Problems Left to Fester

By Annys Shin - Washington Post

The General Assembly adjourned after enacting modest mental-health reforms but leaving broader improvements unaddressed. The outcome has left many to wonder whether meaningful, lasting reform will ever happen: If a school shooting couldn’t do it, if an attack involving a state lawmaker couldn’t do it, then what will?

“It is hard not to be skeptical,” said James Reinhard, a psychiatrist and former commissioner for the Department of Behavioral Health and Developmental Services. “It is a repeated pattern of making recommendations and getting a little bit of effort that is not sustained.”

Advocates for the mentally ill and other experts have long argued that without more services to keep people out of hospitals and give those who are hospitalized a place to go, lawmakers will keep lurching from one crisis to the next.

Read the full article.

Back to the top

Close to Home

By Annie Lowrey - New York Times

Fairfax County, Va., and McDowell County, W.Va., are separated by 350 miles, about a half-day’s drive. Traveling west from Fairfax County, the gated communities and bland architecture of military contractors give way to exurbs, then to farmland and eventually to McDowell’s coal mines and the forested slopes of the Appalachians.

Perhaps the greatest distance between the two counties is this: Fairfax is a place of the haves, and McDowell of the have-nots. Just outside of Washington, fat government contracts and a growing technology sector buoy the median household income in Fairfax County up to $107,000, one of the highest in the nation. McDowell, with the decline of coal, has little in the way of industry. Unemployment is high. Drug abuse is rampant. Median household income is about one-fifth that of Fairfax.

One of the starkest consequences of that divide is seen in the life expectancies of the people there. Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq.

Read the full article.

Back to the top

National News

Resource Shortages

By Digital Journal

When the Georgia House of Representatives recognized Mar. 5, 2014 as Georgia Rural Health Day, it was the latest of a growing stream of acknowledgements that rural populations face unique healthcare challenges due to critical shortages of care resources. Those challenges are increasingly being met with telemedicine initiatives.

109 out of 159 Georgia's counties are considered rural. Their combined populations of more than 2 million face what Georgia HR 1245 described as "a continuing decline in the availability and quality of healthcare providers, specialists, nurses and professional services," with growing uninsured and elderly populations whose healthcare needs "far exceed immediately available care resources." This situation is common among states with significant rural populations.

Read the full article.

Back to the top

Independent? Or Partnership?

By Jacob Barker -Colombia Daily Tribune

Even though it struggled with years of deficits and faced the threat of closure, the 32-bed Cooper County Memorial Hospital had suitors. The Boonville hospital last week decided to go with the for-profit Kansas City company Rural Community Hospitals of America, or RCHA.

The Boonville hospital has had a busy couple of months as it sought a way out of a fiscal hole that small, rural health care providers are increasingly falling into. The announcement followed an effort by state lawmakers from the area to pass legislation that would have allowed Boone Hospital Center and its operator, BJC HealthCare, to enter into a business agreement with or lease Cooper County Memorial Hospital.

The Boonville hospital's viability as an independent provider was facing the same strain as small hospitals throughout the country.

Read the full article.

Back to the top

The ACA in Rural PA

By Kristal Jones and Brandn Green - The Daily Yonder

The Affordable Care Act (ACA) has been spun as the worst assault on the free market and quality health care since communism.  On the other end of the spectrum, the enrollment of 4 million individuals by the end of February is hailed as evidence of unmitigated success, even as website issues and logistical changes continue. 

The reality of ACA implementation is, of course, less cut-and-dry and more overcast with an uncertain forecast.  In rural areas, which received little federal funding for public education and enrollment assistance, it is especially difficult to assess where things stand. 

We are rural sociologists who have been working with a group of undergraduate students, university faculty and local health-care providers to support ACA implementation in rural central Pennsylvania. We have observed first-hand the unique challenges and possible contributions of the ACA for rural areas.  We hope our observations can help support efforts by other groups to deliver ACA to rural areas around the country.

Read the full article.

Back to the top

Rural Publications

The Need for Support of Stroke-Ready Certification in Rural United States: An Overview
Partnerships with Primary and Comprehensive Stroke centers facilitate continuity of care from the rural setting to higher levels of care, creating optimal patient outcomes and reducing clinical risk. Primary and Comprehensive Stroke Certification programs in urban areas has unequivocally demonstrated improved patient outcomes. Stroke Ready Certification has been recognized by the Brain Attack Coalition as essential for the rural setting.

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics
nFP can be a useful tool in both rural and urban settings to screen for diabetic retinopathy in patients who are nonadherent to the recommended dilated annual eye exam. In our study population, a surprisingly higher percentage of diabetic subjects screened from the urban clinic had retinopathy compared with subjects screened in rural clinics.

Shared Care Combined with Telecare Improves Glycemic Control of Diabetic Patients in a Rural Underserved Community
Shared care combined with telecare could significantly reduce HbA1c levels in type 2 diabetic patients with poor glycemic control in underserved rural communities. Further studies should be conducted to clarify the target users and to develop cost-effective interventions.

2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
The Patient Protection and Affordable Care Act of 2010 established bonus payments to reward Medicare Advantage (MA) plans with high quality ratings (4 stars or higher) beginning in 2012. In addition, the Centers for Medicare and Medicaid Services created a demonstration project that expanded the quality-based bonus payments to plans with lower quality ratings (3 stars or higher) from 2012 through 2014. This brief analyzes differences in quality and payment and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans. This suggests that the focus on quality improvement for MA plans should be on the type of plan, not its location.

Meaningful Use of Electronic Health Records by Rural Health Clinics: Working Paper & Policy Brief
Little information is available on the rate of Electronic Health Record (EHR) adoption by Rural Health Clinics (RHCs). This study was conducted to identify the rates of EHR adoption among a national random sample of RHCs and the extent to which RHCs that have adopted an EHR are likely to achieve Stage 1 meaningful use. To achieve Stage 1 meaningful use and qualify for meaningful use incentive payments, eligible health professionals must, at a minimum, meet CMS defined criteria for the required 14 core measures. Fifty-nine percent of RHCs report having an EHR, and independent RHCs were more likely than hospital-based RHCs to have an EHR. Common barriers to EHR adoption by RCHs include acquisition and maintenance costs, lack of capital, and potential productivity or income loss during transition.

Discharge to Swing Bed or Skilled Nursing Facility: Who Goes Where?
Examines health conditions of patients discharged from rural Prospective Payment System (PPS) hospitals and Critical Access Hospitals (CAHs) to swing beds and skilled nursing facilities (SNFs). Patients discharged to facility-based, post-acute care from CAHs are sent to SNFs and swing beds almost equally. Those discharged from rural PPS hospitals predominantly are sent to SNFs. This is the fourth and final brief in a series of studies to better understand swing bed utilization and cost.

Supervision, Support and Mentoring Interventions for Health Practitioners In Rural and Remote Contexts: an Integrative Review and Thematic Synthesis of The Literature to Identify Mechanisms for Successful Outcomes
Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for
staff in rural and remote contexts.

Hope of rural women caregivers of persons with advanced cancer: guilt, self-efficacy and mental health
Caring for a person with advanced disease can have a detrimental impact on the quality of life of family caregivers. This is further compounded in rural areas that have few or no palliative care services. Hope has a positive influence on the quality of life of family caregivers of persons with advanced cancer but factors influencing hope specifically in rural women caregivers of persons with advanced cancer have not been examined.

Do Rural Patients with Early-Stage Prostate Cancer Gain Access to All Treatment Choices? Policy Brief & Final Report
This study compares rates of receipt of four definitive treatments (surgery or one of three types of radiation therapy) for early stage prostate cancer in patients living in urban and four levels of rural counties in 10 states. In general, the findings indicate that rural early-stage prostate cancer patients were able to gain access to the full range of prostate cancer treatment options that were available. Some geographic areas were identified where patients might require additional support to gain access to a full range of treatment services.

Development of the Nursing Community Apgar Questionnaire (NCAQ): a rural nurse recruitment and retention tool
Health professional shortages are a significant issue throughout the USA, particularly in rural communities. Filling nurse vacancies is a costly concern for many critical access hospitals (CAH), which serve as the primary source of health care for rural communities. CAHs and rural communities have strengths and weaknesses that affect their recruitment and retention of rural nurses. The purpose of this study was to develop a tool that rural communities and CAHs can utilize to assess their strengths and weaknesses related to nurse recruitment and retention.

Which Medicare Patients Are Transferred from Rural Emergency Departments?
This study analyzes transfers of Medicare beneficiaries who received emergency care in a CAH or rural hospital and were transferred to another hospital for care. Key findings include the following:
- Among Medicare beneficiaries who received same-day emergency care and inpatient care in 2010, the inpatient stay was in a different hospital for 76.1% of the Critical Access Hospital (CAH) emergency claims, compared to 9.0% for rural non-CAHs, and 2.1% for urban hospitals.
- The majority of transferred CAH and rural non-CAH emergency patients went to urban hospitals for inpatient care. By diagnosis, most transferred patients with intracranial injuries and cardiac-related diagnoses went to urban hospitals, while 42%-48% of patients with certain mental health diagnoses were transferred to other CAHs or rural non-CAHs.

Supporting Iowa Rural Provider Capacity Through Community Care Coordination Teams
Shared community-based teams are a growing trend among states seeking to build provider capacity, especially for small and rural practices. This brief explores Iowa's path to piloting shared community-based teams, from conception and planning to launch, and offers a framework for policy action for states and other organizations considering leading similar efforts. Iowa was one of six states selected to participate in NASHP's 15-month Medicaid-Safety Net Learning Collaborative, supported by a cooperative agreement with the Health Resources and Services Administration (HRSA).

Back to the top


Mark Your Calendar

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

April 10-11: Reduce Tobacco Use Conference - Arlington
April 22: NRHA's Rural Medical Educator's conference - Las Vegas, NV
April 22-25: NRHA's Annual Conference - Las Vegas, NV
April 22-24: National Rx Drug Abuse Summit - Atlanta, GA
May 7: Improving Health Care for Veterans Begins With You - webinar
May 12-16: Behavioral Health and Integration Training Institute - Radford
May 21: Project REVIVE! - webinar


Back to the top


Diabetes Self-Management Education and Training
NACCHO's factsheet provides information on diabetes self-management education and training programs, compares their characteristics, and provides links to more information and resources. 

Where You Live Matters to Your Health
The County Health Rankings provide a health snapshot for nearly every county in all 50 states. See how well your county is doing on 29 factors that influence health, including smoking, high school graduation, employment, physical inactivity, access to healthy foods, and more.

Health Reform Facts
Resource for Virginians wanting to learn about the Affordable Care Act and healthcare access.

President's Budget: Selected Resources and Reactions
President Obama released his 2015 budget proposal on March 4th which outlines the Administration’s suggested priorities for Congress as they work to put forth a 2015 federal budget to be enacted October 1st. Here are some useful links to access official budget documents, as well as see selected reactions from the field.

The Uninsured: An Analysis by Age, Income, and Geography
Using the 2010 Small Area Health Insurance Estimates, RUPRI analyzed the rural and urban uninsured populations by age, showing that in both places, uninsured rates decline dramatically with age. We find that, within each age group, rural uninsured rates are somewhat lower than urban uninsured rates at income levels below 400% of the Federal Poverty Level. However, since a greater proportion of the rural population falls into the age and income categories with high uninsured rates, rural people as a group stand to benefit slightly more from subsidized coverage through the Health Insurance Marketplaces (HIM) or Medicaid expansion (if enacted). Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive HIM premiums upward, an effect which may be mitigated or compounded by various other factors.


Back to the top

Funding Opportunities

Rural Access to Emergency Devices
DEADLINE: April 30
Provides support to develop community partnerships to purchase automated external defibrillators (AEDs), provide defibrillator and basic life support training, and place the AEDs in rural communities with local organizations. Community partnerships composed of local emergency response entities such as community training facilities, local emergency responders, fire and rescue departments, police, community hospitals, and local non-profit entities and for-profit entities concerned about cardiac arrest survival rates are eligible to apply.  Each community partnership must evaluate the local community emergency response times to assess whether they meet the standards established by national public health organizations such as the American Heart Association and the Red Cross.¿  Each community partnership must clearly identify the lead applicant from the group of entities making up the partnership.

Reduce Hepatitis Infections by Treatment and Integrated Prevention Services (Hepatitis-TIPS) among Non-urban Young Persons Who Inject Drugs
DEADLINE: April 14
The purpose and overarching goal of this cooperative agreement is to address the high prevalence of viral hepatitis C infection by developing and implementing an integrated approach for detection, prevention, care  and treatment of Hepatitis C infection among young (18-30 year old), non-urban people who inject drugs (PWID).  Awardees will develop and implement a comprehensive strategy to enroll young non-urban PWID, collect epidemiological information, test for HCV infection and provide linkage to primary care services and prevention-based education.  In addition to providing hepatitis C virus (HCV) testing, awardees will provide testing for the presence of co-infections with hepatitis B virus (HBV) and HIV. Rates of HCV infection or re-infection will be evaluated through follow-up assessment.

Toyota U.S.A. Foundation
The Toyota U.S.A. Foundation is committed to improving the quality of K-12 education throughout the country by supporting innovative programs and building partnerships with organizations dedicated to improving the teaching and learning of mathematics, science, and environmental science. The Foundation places priority on programs that are broad in scope and incorporate systemic approaches, creative programs that develop the potential of students and/or teachers, and cost-effective programs that possess a high potential for success and relatively low duplication of effort. Grants of $50,000 and up are provided to colleges and universities as well as nonprofit organizations engaged in pre-collegiate math and/or science education. K-12 public and private schools are not eligible to apply.

Back to the top