Virginia Receives Grants to Expand Primary Care Workforce

HHS Secretary Kathleen Sebelius has announced $320 million in grants under the Affordable Care Act (ACA) to strengthen the health care workforce. Of those grants, $253 million will go to improve and expand the primary care workforce under the Prevention and Public Health Fund of the Affordable Care Act. Another $67 million in Health Profession Opportunity Grants will provide low-income individuals with education, training and supportive services that will help them prepare to enter and advance in careers in the healthcare sector. Here are the Virginia award recipients:

Advanced Nursing Education Expansion
Shenandoah University Winchester $1,188,000.00

Expansion of Physician Assistant Training Program
Shenandoah University Winchester $1,069,200.00

Primary Care Residency Expansion
Virginia Commonwealth University Richmond $1,585,520.00
Carilion Medical Center Roanoke $1,920,000.00

Nurse Managed Health Clinics
St. Mary's Health Wagon, Inc. Clinchco $1,493,634.00

State Health Care Workforce Grants: Implementation
Virginia State Department of Health Richmond $1,935,137.00

TOTAL: $9,191,491.00

Virginia Health Professional Grants: $2.8 Million

HHS Secretary Kathleen Sebelius announced $130.8 million in grants to strengthen and expand the health professions workforce. Six areas are targeted: primary care workforce training, oral health workforce training, equipment to enhance training across the health professions, loan repayments for health professionals, health careers opportunity programs for disadvantaged students, and Patient Navigator outreach and chronic disease prevention in health disparity populations. The grants include $88.7 million in funding from the American Recovery and Reinvestment Act. $2.8 million is coming to Virginia! Congrats to all the recipients!

ARRA - Equipment
Virginia Highlands Community College Abingdon $293,718.00
James Madison University Harrisonburg $192,378.00
Southwest Virginia Community College Richlands $300,000.00
Bon Secours Richmond Health Care Foundation Richmond $300,000.00
Bon Secours Richmond Health Care Foundation Richmond $147,375.00

ARRA - Training in Primary Care Medicine and Dentistry: Residency Training in Primary Care
Eastern Virginia Medical School Norfolk $800,000.00

Grants to States for Loan Repayment
Virginia State Department of Health Richmond $400,000.00

Pre-Doctoral Training in Primary Care
Eastern Virginia Medical School Norfolk $330,250.00

Virginia Health Professional Grants: $5.6 Million

HHS Secretary Kathleen Sebelius will announce $159.1 million in grants to health care workforce training programs that will support programs to train nurses, geriatric specialists and improve the performance and recruitment of underrepresented minority students. Here are the grantees from Virginia. Congrats to all:

Advanced Education Nursing Grants
The Rector and Visitors of the University of Virginia Charlottesville $408,395.00
Hampton University Hampton $382,846.00
Old Dominion University Research Foundation Norfolk $236,764.00
Old Dominion University Research Foundation Norfolk $246,966.00
Virginia Commonwealth University Richmond $210,581.00
Shenandoah University Winchester $248,621.00

Advanced Education Nursing Traineeship Grants
Marymount University Arlington $13,184.00
University of Virginia Charlottesville $79,150.00
George Mason University Fairfax $64,146.00
Hampton University Hampton $39,647.00
James Madison University Harrisburg $26,795.00
Old Dominion University Research Foundation Norfolk $47,528.00
Radford University Radford $26,241.00
Carilion Medical Center (doing business as Jefferson College of Health Sciences) Roanoke $18,992.00
Shenandoah University Winchester $35,215.00

Nurse Anesthetist Traineeship Grants
Old Dominion University Research Foundation Norfolk $4,184.00
Virginia Commonwealth University Richmond $27,488.00

Nurse Education, Practice, Quality and Retention Grants
Virginia Highlands Community College Abingdon $1,221,175.00
George Mason University Fairfax $313,170.00
Hampton University Hampton $266,381.00
Old Dominion University Research Foundation Norfolk $238,175.00

Nursing Workforce Diversity Grants
Hampton University Hampton $399,305.00
Southwest Virginia Community College - Virginia Appalachian Tricollege Nursing Program Richlands $306,394.00

Geriatric Education Centers Grants
Virginia Commonwealth University Richmond $413,113.00

Comprehensive Geriatric Education Programs Grants
George Mason University Fairfax $157,481.00
Radford University Radford $124,368.00

Want to Learn How to Use the Geospatial (Mapping) Component of the Virginia Rural Health Data Portal?

Here is a simple screencast demonstration of the geospatial component of the Virginia Rural Health Data Portal.

Telemedicine As One of the State Rural Health Plan's Recommendations For Addressing Access to Care

"Promote a statewide telehealth system for health care" is one of the recommendations for addressing the access to care issue. This video provides a prime example of this here in Virginia!

More On Integrating Behavioral Health with Primary Care

As most of you know, two of the recommendations of the Virginia Rural Health Plan Access Council are:

Research existing models of care that integrate primary care with mental/behavioral health within Virginia and in other states.

and

Develop pilot projects that focus on the integration of quality systems of care.

A major report just came out this month (May 2010) entitled: "Evolving Models of Behavioral Health Integration in Primary Care". The Milbank Memorial Fund commissioned this report to provide policymakers with a primer on integrated care that includes both a description of the various models along the continuum and a useful planning guide for those seeking to successfully implement an integrated care model in their jurisdiction. Take a look!

Best Practices and Models of Care in Rural Health

The Access Council of the Virginia State Rural Health Plan has issued Best Practices and Models of Care in Rural Health. The compendium compiles best and promising practices and models of care for rural health in the following four specialized areas: oral health, maternal and newborn health, behavioral and mental health, and telemedicine and telehealth. The document will serve as a resource for implementing the recommendations of the Virginia State Rural Health Plan, including effective new programs and practices to address Virginia’s most challenging health issues.

Give a Child a Smile Day

VCU Pediatric Dental Clinic will see any child (0 - 15 years) that needs dental services - Free of Charge! Dental care at this event will include cleaning, extractions and minor restorative work (as much work as possible will be done on this day for your child starting with the most urgent dental needs)

One day only: February 5, 2010 from 7:30 AM - 1:30 PM

Location: VCU/MCV at 521 N. 11th Street, 3rd Floor; Suite 315, Richmond, VA

Appointments are strongly urged as the number who will participate is expected to b e high. Please call 804-828-9095 to secure your child's appointment.

Since this event is part of the national "Give a Child a Smile Day" initiative, other events may be occurring at other sites in Virginia as well.

"Health Disparities in Rural Settings" Graduate Level Course Via Podcast with 1.8 CE credits

Shenandoah University Division of Nursing’s Graduate Program is offering a course titled “Health Disparities in Rural Settings.” It is available for 1.8 CE credits from the Virginia Nurse’s Association and the American College of Nurse-Midwives and is offered through podcasts that can be downloaded onto ipods through iTunes U.

This course analyzes the complex health disparities that occur in rural settings and that are rooted in historic and contemporary inequities. Topics include discussions of health care systems, health policies, distributions of resources, community needs assessment strategies, access to health care professionals and ethical considerations. Existing multi-level intervention strategies aimed at eliminating health disparities will be assessed, including those specific to rural settings as well as community-academic partnerships that translate research into action.

The podcasts are lectures and interviews with experts in the field. They can be downloaded from www.shenandoahgraduatenursing.com Go to “Electives and CEUs.”
Click on “Health Disparities in Rural Settings”
On ITunes U, get all lectures and subscribe to the course. By subscribing, you will be able to get new interviews as they occur.

When you are finished with the course, fill out the “Health Disparity CE Evaluation Form”. Email jfehr@su.edu notifying us that the Evaluation form has been filled out. Give us your address so that we can mail you your certificate.

Rural Healthcare Workforce Recognition Awards

Just a reminder to submit your nominations. For more information, visit Virginia's State Rural Health Plan Rural Healthcare Workforce Recognition Awards web page!

Let us know about your rural community success stories!

The National Rural Health Association in partnership with the National Offices of State Offices of Rural Health will be sponsoring the Rural Health Policy Institute at the end of this month. They are collecting success stories of rural communities at work to improve rural health.

If you have something to share, please share it as a comment on this blog! Please include information on the name of community – and a little narrative about the project or the success of the community. They are interested in hearing about workforce initiatives, initiatives to increase access to health services or promote health – or any other success story you can share!

We would love to pass along several Virginia success stories to be featured at the Rural Health Policy Institute!

Announcing the New Virginia Rural Health Data Portal

The Virginia Rural Health Data Portal puts information, that was once scattered, in one place and in your hands. Create, print and download maps, charts and graphs. Now you have the tools to tell your rural health story.

The Virginia Rural Health Data Council, in conjunction with the Virginia Department of Health and the Virginia Rural Health Association, are pleased to introduce the Virginia Rural Health Data Portal, a web-based tool that has been developed to provide a unique source of information on topics of special interest to rural health providers, researchers, grant writers, and others interested in telling their story on health issues facing rural populations in Virginia. The data currently presented in the portal are related to the issues and strategies defined in the Virginia State Rural Health Plan. It is anticipated that as additional issues are studied, new data sets will be added to the site. In addition, there will be several improvements added in the next few weeks, so check back often!

This is how you use the mapping tool:


This is how you generate charts and graphs:


Let us know what you think!

Establishing a Vision for Health Workforce Development in Virginia

This blog site has been created to obtain input on the final draft set of recommendations regarding Code language for establishing an Authority structure to facilitate the development of the health workforce in Virginia.  This consolidated set of recommendations is the result of a series of meetings with stakeholders over the course of the past six months:

http://healthcareworkforceinva.blogspot.com/

The legislation to develop an Authority structure in Virginia stems partially from the processes and recommendations regarding the health workforce from Virginia's State Rural Health Plan.  Recommendations for Code language will be going to the General Assembly in a study report at the end of November, so this is the final opportunity for public comment before the completion of the study report.  Please take the time to read through the recommendations and provide your input on/before noon on Friday November 13, 2009. Your contributions are important in shaping this proposed legislation.

Rural EMS Summit: Sharing Solutions and Strategies

December 10-11, 2009
Central Virginia Community College
Lynchburg, Virginia

Who should attend? Local Government Officials, EMS Leaders and Providers and Community Healthcare Providers

Register Before November 30, 2009.

The Virginia Office of EMS is sponsoring The Rural EMS Summit to develop strategic initiatives and objectives for a state plan to address the needs of rural EMS agencies in Virginia. The summit is scheduled for December 10 and 11, 2009 in Lynchburg, Virginia.

Despite the improvement in EMS service to the rural areas of Virginia there are some looming problems. In March 2009, participants at a Rural EMS Roundtable function identified a number of deficiencies and prioritized the top three challenges facing EMS agencies in rural areas as

1. EMS Agency Leadership and Management
2. Local government involvement/accountability, and
3. Recruitment and Retention of EMS personnel.

Kevin McGinnis, MPS, EMT-P will be the key note speaker and meeting facilitator. Kevin is the Program Advisor to the National Association of State EMS Officials, a former state EMS director and the author of the Rural and Frontier Emergency Medical Services Agenda for the Future.

This meeting is a collaborative effort of the Virginia Department of Health, Office of Emergency Medical Services and the Office of Minority Health and Public Health Policy Division of Primary Care and Rural Health. Funding for this event is provided through a Health Resources and Services Administration (HRSA) Flex Grant.

Learn More...

Coming Soon - Virginia Rural Health Data Portal!

A portion of Virginia's State Rural Health Plan deals with defining “rural” and developing a database that could be used for such things as identifying disparities between urban and rural settings and studying rural health trends here in Virginia.

One of the goals of the Data and Rural Definitions Council was to develop a web-based data portal to allow the public access to this data. The rural health data portal is about to become a reality!

This data portal will be introduced to the public for the first time at the 2009 Virginia Association of Free Clinics and the Virginia Rural Health Association Joint Conference in November. Not registered yet? Act fast! The deadline for discounted registration and hotel rooms is October 21. Come see how to use the portal and the data and mapping capabilities available at a session in the afternoon on Monday November 16. See the conference agenda here!

Integrating Primary Care and Behavioral/Mental Health

The Virginia State Office of Rural Health began an effort to promote an integrative model of primary and behavioral/mental health care last year by making available small planning grants, funding research to explore existing models if integrated care in Virginia, and by providing training at the March 2009 Rural Health Summit (presentations from the trainings can be found here). Further exploration of this model of care was also one of the recommendations of the Virginia State Rural Health Plan.

The following announcement was issued last month by the American Academy of Physicians:

The AAFP's National Research Network, or NRN, is recruiting practices for its new subnetwork, the Collaborative Care Research Network, or CCRN. The new network is designed to investigate and evaluate the integration of mental health services in primary care settings.

A study published online in Health Affairs in April found that two-thirds of primary care physicians don't have access to mental health specialists because of numerous barriers, including lack of mental health professionals and insurance restrictions.

According to Rodger Kessler, Ph.D., a research assistant professor in the department of family medicine at the University of Vermont College of Medicine, Burlington, mental health is the most difficult specialty for family physicians to access.

"When a physician refers a patient out to mental health providers, only 20 percent to 40 percent (of those visits) result in care being initiated," said Kessler, who also is the research director of the CCRN. "It just doesn't happen." The CCRN, however, is studying a new treatment model for mental health services.

The new model, said Kessler, would involve in-house medical teams who would work together to plan treatments and execute a patient's care. The expectation is that combining mental health, substance abuse and physical health services in this kind of team structure will produce better outcomes than the old referral system.

Benjamin Miller, Psy.D., assistant professor in the department of family medicine at the University of Colorado School of Medicine, Denver, said that although this type of collaborative care seems like a good concept, the CCRN needs practice-based evidence to support that theory.

The purpose of the CCRN, "isn't just to get another research paper out there," said Miller, who also is the administrative director of the CCRN. "It's to shape and change the landscape of health care."

Integrating mental health into primary care is a relatively new idea, said Kessler, but it is a vital part of the patient-centered medical home because primary care physicians provide the greatest portion of care for mental health and substance abuse.

In addition, Kessler noted that a number of other common medical issues dealt with by primary care physicians, including chronic pain, insomnia and gastrointestinal disorders, would benefit from a collaborative care approach.

Issues such as hypertension, smoking cessation and weight loss also are behavior-related and could benefit from collaborative care, said Miller.

"(The CCRN) is a response to the fragmentation we see in the health care system," Miller said. "If you're going to be sent across the street or down the hall, most people just don't go for that."

The CCRN has recruited about 30 practices to date and hopes to add 50 practices a year during the next two years, according to Kessler. The eventual goal is to have 150 to 200 practices nationwide working together to make collaborative care more effective.

In addition to having a mental health professional on staff, primary care practices participating in the CCRN need to have an interest in practice-based research, a willingness to share data and an interest in addressing important research questions, said Kessler.

The CCRN has received funding from the Agency for Healthcare Research and Quality to convene an invitation-only meeting Oct. 8-9 in Denver to create a research agenda for behavioral health in primary care. Kessler said he expects to have representation from the primary care and mental health fields, as well as government agencies, including the Department of Defense and the Department of Veterans Affairs.

Kessler and Miller also plan to take their message directly to health care professionals with sessions during the Collaborative Family Healthcare Association's conference Oct. 22-24 in San Diego and during the AAFP's Conference on Practice Improvement Nov. 5-8 in Kansas City, Mo.

Practices interested in obtaining an enrollment packet should contact Mindy Spano with the AAFP's National Research Network at (800) 267-2237, Ext. 3178.

Source: http://www.aafp.org/online/en/home/publications/news/news-now/clinical-care-research/20090805ccrnlaunch.html

Right here in rural Virginia, the Southwest Virginia Community Health Systems Inc. has been testing this integrative care model and will soon have available outcomes research using two years of clinical data.

Health Status and Health Care Access of Farm and Rural Populations

Check out this new report by the Economic Research Service that was released last week! This report focuses on the health status and health care access of members of the Nation’s rural households and farm-operator households in comparison with those of urban and nonfarm households.

Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts, though mortality and disability rates vary more by region than by metro status. Contributing negatively to the health status of rural residents are their lower socioeconomic status, higher incidence of both smoking and obesity, and lower levels of physical activity. Contributing negatively to the health status of farmers are the high risks from workplace hazards, which also affect other members of farm families who live on the premises and often share in the work; contributing positively are farmers’ higher socioeconomic status, lower incidence of smoking, and more active lifestyle. Both farm and rural populations experience lower access to health care along the dimensions of affordability, proximity, and quality, compared with their nonfarm and urban counterparts.

Click here to download the full report

Medicare Payment Policies for Telehealth Services

CMS has recently published a brochure on its Medicare payment policies for Telehealth services. The following link will take you to the brochure:
http://www.cms.hhs.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

Practicing Excellence: A small-town, rural doctor embraces technology

Here is one small rural doctor's experience with Electronic Health Records!

Practicing medicine takes on a different feel when you're the only doctor in town. But Jim Selenke, MD, the lone physician in Hudson, Iowa, wouldn't have it any other way.

"The rural practitioner has to be incredibly confident in his skills and able to address the unpredictable," says Selenke, a family physician. "You have a lot less control over your schedule. Patients often walk in unannounced with a wide variety of ailments."

One man hurt himself while securing a load to his truck and showed up at Selenke's door with the metal hook of a bungee cord still stuck in his eyelid. There was the elderly woman whose car veered off the road near Selenke's practice before a passerby brought her—unresponsive and without a pulse—to his office. In the midst of performing a well-baby exam, Selenke dashed outside, intubated the woman, and performed CPR before an ambulance arrived to stabilize her.

But patient care is only part of Selenke's job. He handles the landscaping outside his practice, fixes its plumbing, maintains his office computer systems—he even changed the tire on a patient's car recently, a deed that was rewarded with a batch of what he calls the best cookies around.

"In primary care and in a small town, if you want to survive, you put on multiple hats," says Selenke, who is known to everyone in town as "Dr. Jim."

Rural patients tend to be older, poorer, less likely to have private insurance, and more likely to suffer serious injury from accidents compared to their urban counterparts, according to the National Rural Health Association. Plus, Medicare reimbursement tends to be lower, and providers are harder to come by, ratcheting up the pressure on those who serve such areas.

For the most part, Selenke's patient population mirrors the trends typical of rural America: About 40 percent of his 4,000 patients are on Medicare. He practices five days a week and manages to see about 35 patients per day.

He keeps up that prodigious pace with help from his electronic health record system, an investment he made five years ago when he first opened his own practice. He also decided then to maximize his efficiency and lower his overhead by teaching himself what he needed to know to maintain his IT systems. Though going high-tech—and mostly going it alone—was a choice few others in his shoes would likely make, it has made all the difference for Selenke.

Read more...

Taking the Pulse of Rural Health Care

New health information technologies hold promise for improving health care in remote areas.

Reforming the U.S. health care system is high on the national policy agenda. Debate over U.S. health policy has focused on expanding health insurance coverage, improving the quality of health care, and reducing costs. These three goals are interrelated because lack of insurance coverage and poor coordination of services across care providers tend to drive up costs.

Within this broader context, rural households confront special health care challenges due to their lower socioeconomic status, higher average age, and greater geographic dispersal than the U.S. population as a whole. Rural households, on average, have less education and fewer financial resources, both of which are associated with lower health status. Approximately 15 percent of rural residents (compared with 12 percent of urban residents) are age 65 or older, which leads to a greater incidence of chronic disease and disability. Lower population densities in rural areas mean that residents must typically travel longer distances for health services, especially for specialty care.

Read more...