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Hello Everyone!
Happy New Year!
We have been busy here at TASC with site visits, planning a great Reverse Site Visit (July 17-18) and the April Flex Workshop (April 10-12). Thank you to the Maine State Office of Rural Health (SORH) and the Alaska SORH for great Flex Program site visits.
That time of year has come again, it is time for you to nominate a critical access hospital (CAH) that has implemented innovative initiatives integrating behavioral or mental health. Please see below for more details.
Enjoy this month's edition of Rural Route and thanks for reading.
As always please send any pictures you happen to take along your travels. We enjoy highlighting the beauty found in the places we serve.
Until next time,
Caleb Siem, MH
Program Specialist
Technical Assistance and Services Center (TASC)
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Welcome and Farewell
Welcome to:
- Tim Held, Interim State Office Director, Minnesota
- Andy Klitzke, State Office Director, South Dakota
- Janice Johnson, Flex & SHIP Coordinator, Florida
Farewell to:
- Mark Shoenbaum, State Office Director, Minnesota
- Gloria Davis, Flex Coordinator, Alabama
We encourage you to keep your Flex staff contact information current by completing the new
Flex Contact Information Form
as soon as possible whenever there are changes in your office. Please review your contacts as listed in your
State Flex Profile and complete the form as necessary for any additions or changes.
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Sarah Young, FORHP |
Happy New Year,
If you weren't able to join the Virtual Knowledge Group (VKG) Webinar on January 8 about critical access hospital (CAH) financial improvement strategies, you'll definitely want to
watch the recording. Terry Hill, Caleb Siem from the National Rural Health Resource Center and Kristen Reiter from the Flex Monitoring Team led a great discussion about Flex strategies for working with CAHs to improve their operations and financial stability.
As far as upcoming Flex grant deliverables, Fiscal Year (FY) 2016 Federal Financial Reports (FFRs) were due January 30, 2018, and carryover requests are due no later than March 1 (30 days after the FFR due date). Please ensure you are working with your finance office to meet those deadlines. We will reject any initial carryover requests submitted in the Electronic Handbooks (EHB) after March 1. Flex Programs may continue working with project officers to revise existing requests after March 1.
Flex Programs with unspent funds from FY16 may request carryover, but it's not required. You should only ask for carryover if you have the capacity to take on additional work and if there are incomplete projects and identified needs that you can effectively address with the funds. Also, keep in mind that FY16 carryover must be used for planned activities within the scope of your FY16 work plan and can't be used to start new projects.
In Medicare Beneficiary Quality Improvement Project (MBQIP) news, I hope everyone saw that the webinar with the Centers for Disease Control and Prevention (CDC) about the
National Healthcare Safety Network (NHSN) Annual Facility Survey
has been rescheduled to February 7. If you or your CAHs have questions about the NHSN survey this will be the place to learn from the NHSN experts.
Anyone that was registered for the originally planned date of January 23rd will need to register again for the event.
Please keep sharing your suggestions and feedback on PIMS. The system is a work in progress and you are helping us iterate and improve Flex data collection.
Thank you for your hard work on behalf of CAHs and rural communities.
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CAH Regulatory Update
Labor Department - Association Health Plans Proposed Rule
The Department of Labor has issued a
proposed regulation that would expand the opportunity for small businesses to offer employment-based health insurance through Small Business Health Plans, also known as Association Health Plans (AHPs). Broadening the definition of 'employer' to allow AHPs to offer insurance under Title I of the Employee Retirement Income Security Act (ERISA) would exempt AHPs from state regulation and some Affordable Care Act (ACA) requirements.
The proposed regulation also seeks comment on allowing small employers, including those in rural communities, to form an AHP on the basis of geography or industry, so a health plan could serve employers in a state, city, county or a multi-state metro area, or it could serve all the businesses in a particular industry nationwide.
Comments are due March 6, 2018. See the
fact sheet
for more information.
Federal Communications Commission (FCC) Promoting Telehealth in Rural America Proposed Rule
On January 2, 2018, the FCC published in the Federal Register a
proposed rule with policy proposals to ensure that rural health care providers get the support they need while guarding against waste, fraud and abuse. The rule considers a series of measures to ensure the Rural Health Care (RHC) Program operates efficiently and considers the appropriate size of the funding cap. The Commission also takes targeted, immediate action in the Order section of the item to mitigate the impact of the existing RHC Program cap on rural healthcare providers in fiscal year (FY) 2017.
Comments are due February 2, 2018. You may submit comments, identified by WC Docket No. 17-310, by any of the following methods:
- Follow the instructions for submitting comments via the Federal eRulemaking Portal
- Follow the instructions for submitting comments via the FCC website
- People with Disabilities: Contact the FCC to request reasonable accommodations (Accessible format documents, sign language interpreters, etc.) by email: FCC504@fcc.gov, phone: (202) 418-0530 or TTY: (202) 418-0432
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2018 Flex Program Reverse Site Visit
We are pleased to announce that the 2018 Flex Program Reverse Site Visit (RSV) will be held July 17-18, 2018 at the
Omni Shoreham Hotel in Washington, DC. This in-person Flex grantee meeting is supported by the Federal Office of Rural Health Policy (FORHP).
The purpose of the Flex Program RSV is to highlight the latest information and issues in the Medicare Rural Hospital Flexibility (Flex) Program, as well as offer states an opportunity to share experiences, lessons learned and successes in a collaborative learning environment.
Online registration for the Flex Program RSV will open in March 2018. A draft agenda for the for the event is currently in development. Information regarding hotel booking and room rates will be forthcoming. Further information will be provided as it is made available. Please don't hesitate to contact us if you have any questions.
The intended audience for the Flex Program RSV is State Office Directors, Flex Coordinators/other key Flex personnel (two per state), the Flex Monitoring Team (FMT), Rural Quality Improvement Technical Assistance (RQITA), the TASC Advisory Committee and staff of FORHP. If you would like to have more than two attendees, please contact your project officer at FORHP for approval.
Concurrent to the Flex Program RSV, the National Rural Health Association (NRHA) and FORHP Community-Based Division will be hosting events at the Omni Shoreham Hotel. This will be a prime opportunity to network with your fellow state constituents.
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Flex Program Fundamentals Guide Updated!
The Flex Program Fundamentals Guide has been updated for 2018. The Flex Program Fundamentals Guide is a manual for those intimately involved with the Flex Program and is updated by TASC annually. We hope the Flex Program Fundamentals: An Introduction to the Medicare Rural Hospital Flexibility Program, is useful both as a resource for current Flex Program staff and as an orientation manual for new staff. The online version of the guide is available by section on the
TASC website. The guide includes the following sections:
- Introduction to the Flex Program
- Federal Office of Rural Health Policy
- Introduction to the Technical Assistance and Services Center
- Flex Monitoring Team
- Rural Quality Improvement Technical Assistance
- Flex Coordinator Reference
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National Rural Health Information Technology (HIT) Coalition Face-To-Face Meeting
The National Rural Health Information Technology (HIT) Coalition is holding an in-person meeting during the
National Rural Health Association Rural Health Policy Institute. The National Rural HIT Coalition meeting will be held
Tuesday, February 6, 2018 from 4:30 p.m. - 6:00 p.m. Eastern Time at the
Omni Shoreham Hotel in Washington, DC. Topics will include national and legislative updates in HIT, telehealth and others to be determined.
If you would like to attend the February 6th meeting of the Coalition or participate by phone, please email Nicole Clement at the National Rural Health Resource Center at nclement@ruralcenter.org.
The Rural HIT Coalition is a network of rural and health information technology leaders from regional, state, national and federal organizations, working together to advance the implementation of HIT across rural America. The Coalition addresses key issues facing Rural HIT adoption including: ensuring HIT workforce; establishing business processes; connecting rural health care communities; promoting quality initiatives; pursuing needed IT infrastructure; ensuring rural citizen access; and assisting with the unique needs of minority and special needs populations.
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MBQIP Highlights & Resources
As a reminder, please send your MBQIP questions to the Technical Assistance and Services Center (TASC)
email address. TASC will ensure your question reaches the best person to answer.
MBQIP Data Reporting Reminders
Upcoming Data Submission Deadlines:
January 31, 2018
Emergency Department Transfer Communication (EDTC):
- Patients seen Q4 2017 (October, November, December)
- Submission process directed by state Flex Program
February 1, 2018
CMS Population and Sampling (optional)*
- Patients seen Q3 2017 (July, August, September)
- Inpatient and Outpatient
- Entered via the Secure Portal on QualityNet
February 1, 2018
CMS Outpatient Measures:
- Patients seen Q3 2017 (July, August, September)
- CMS Hospital Inpatient Reporting Specifications Manual version 10.0a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 1.15.1
February 15, 2018
CMS Inpatient Measures:
- Patients seen Q3 2017 (July, August, September)
- CMS Hospital Inpatient Reporting Specifications Manual version 5.2b
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 4.19.2
*Population and Sampling refers to the recording of the number of cases the hospital is submitting to the QualityNet warehouse this is done directly through the QualityNet Secure Portal.
Note:
The entry of Outpatient Population and Sampling data directly into the grid in the QualityNet Secure Portal is again functional.
CMS has announced that four of the Outpatient Measures that are currently required for MBQIP will be removed following Q1 2018 data submissions!
- OP-1: Median Time to Fibrinolysis
- OP-4: Aspirin at Arrival
- OP-20: Door to Diagnosis Evaluation by a Qualified Medical Professional
- OP-21: Median Time to Pain Management for Long Bone Fracture
Submission of these measures will be included in the evaluation of CAH participation in MBQIP for FY 2018, but will be removed from MBQIP evaluation criteria and MBQIP reports starting with Q2 2018 discharges (encounters as of April 1, 2018).
CAHs should continue to collect these measures through Q1 2018 encounters (due 8/1/2018). Starting with Q2 2018 encounters, the measures do not need to be collected, and the QualityNet warehouse will no longer be accepting submission of data for these measures.
Resources
Author: Stratis Health
Stratis Health is offering a customized consultation that will provide critical access hospitals (CAHs) with the opportunity to receive one-on-one education and assistance on how to abstract MBQIP core measures. This is a chance to validate the abstraction process with Stratis Health Quality Reporting Specialist Robyn Carlson, RHIA, CPHQ, using an inter-rater reliability process that compares abstraction results between two abstractors to assess the comparability of findings. Space is limited! Visit the project page for more information or to submit a form to indicate interest in participating.
Author: Stratis Health
This guide and toolkit offers strategies and resources to help CAH staff organize and support efforts to implement best practices for quality improvement.
Author: Agency for Healthcare Research and Quality (AHRQ)
For more than a decade, hospitals have been using this staff survey developed by AHRQ to help assess and improve the culture of safety in their organizations.
Author: Stratis Health
This collection of resources for rural health care organizations points health care quality professionals to the most helpful introductory resources and provides awareness of the more prominent health care quality organizations, programs and terms.
Upcoming Webinars
Wednesday, February 7, 2018, 1:00 - 2:00 Central Time
FORHP and CDC are offering this webinar to provide additional information about completion of the NHSN Annual Facility Survey and use in monitoring implementation of antibiotic stewardship programs. Anyone that was registered for the originally planned date of January 23rd will
need to register again for the event.
Ask Robyn - Quarterly Open Office Hour Calls for Data Abstractors
Scheduled approximately one month before data submission deadlines each quarter, Rural Quality Improvement Technical Assistance(RQITA) Quality Data Specialist Robyn Carlson will be offering open office hour calls to respond to MBQIP data abstraction questions
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2018 dates:
- April 11, 2:00 - 3:00 p.m. Central Time
- June 20, 2:00 - 3:00 p.m. Central Time
Note: registration is required, please follow this
link for details.
MBQIP Monthly
MBQIP Monthly is a monthly e-newsletter that provides CAHs with information and support for quality reporting and improvement and highlights current information about MBQIP. State Flex Programs are encouraged to distribute MBQIP Monthly to their CAHs as an additional resource to supplement state level MBQIP support. The most current version always available on the
MBQIP Monthly webpage
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MBQIP Virtual Knowledge Groups (VKGs)
RQITA and the Technical Assistance and Services Center (TASC) have teamed up to host MBQIP VKG webinars to give you the opportunity to share MBQIP successes, challenges, barriers and brainstorm strategies to assist hospitals towards reporting, participating, improving and excelling in the four MBQIP quality domains.
These calls/webinars are intended for state Flex Program personnel and designated contractors. The next MBQIP VKG call is scheduled for
February 15, 2018, from 2:00 p.m. - 3:30 p.m. Central Time with the topic to be determined.
More information will be sent to the appropriate email lists prior to the call. Recording of previous MBQIP VKG webinars are available in the Flex Program Forum. Contact
Jodi Winters
at Stratis Health with any questions.
Contact
TASC
with your inquiries, questions and comments related to MBQIP and/or resources.
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Since the New Year the Technical Assistance and Services Center (TASC) has kept busy with a couple site visits to Flex Programs on opposite ends of the country. We are working on some updates to some toolkits and upcoming webinars:
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- TASC 90 webinar on February 14 on Outputs and Outcomes for Flex Program Success
- Release of the Cybersecurity Toolkit for Rural Hospitals and Clinics
- Publication of the 2018 State Flex Profiles
- We will be mailing out your Flex Program Fundamentals, also updated online
- Participation in Recommendation Adoption Progress (RAP) coaching calls for all states participating in the Flex Funding Supplement
If you have any questions on any of the above work under development, or an idea for TASC to consider, please let us know by emailing
Tracy Morton.
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Nominate a CAH to be Recognized for Innovative Behavioral or Mental Health Initiatives!
Do you know of a critical access hospital (CAH) that has implemented innovative initiatives integrating behavioral or mental health that are worthy of recognition? If so, please consider nominating them for recognition from the Technical Assistance and Services Center (TASC), a program of the National Rural Health Resource Center, and the Federal Office of Rural Health Policy (FORHP) for their efforts.
CAHs chosen based on scoring criteria listed below will each receive a recognition certificate and be profiled in
Rural Route and also on TASC's
CAH Recognition spotlight webpage. Please plan to present the certificate to the CAH in person.
The initiative must meet the following requirements:
- Be supported by the Flex Program
- Have a well-developed evaluation plan
- Be able to share 2-5 qualitative and/or quantitative outcomes
The criteria that nominations will be scored on include:
- Well-written, compelling story that provides background on why the hospital implemented the initiative(s) (0-3 points)
- Detailed description of the hospital initiative(s) (0-2 points)
- Inclusion of how the state Flex Program supports the CAH in these efforts (0-2 points)
- Clear description, including 2-5 qualitative and/or quantitative outcomes, that explains how the hospital has assessed that the initiative is successful and meeting community needs (0-5 points)
If your nominated CAH(s) are chosen to be recognized, TASC will mail you a certificate for your CAH. We ask that you do the following to present the certificate to the hospital:
- Announce the news! Call the hospital's CEO, notify her/him they are a certificate recipient and schedule a time with them to present the hospital with the certificate
- TASC will provide you a template press release. Use it as appropriate to highlight the CAH within your state and share it with the hospital so they can customize it to share their success with their local media sources
- Send TASC a few photos, such as the staff holding the certificate, of you presenting it to them, etc. to include in Rural Route and on the CAH recognition spotlight webpage
- Collect a quote from the hospital on what this recognition means to them. TASC will include this as well in Rural Route and on the CAH Recognition on spotlight webpage
Nominations will be accepted until February 9, 2018
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| A Great View of Alaska from Tracy Morton, (TASC). |
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New Substance Use Resources
With the additional efforts and projects relating to substance use, TASC worked with John Gale from the Flex Monitoring Team to identify resources that might be useful to
you and your hospitals as you work to meet the challenges of substance use/abuse. TASC continues to identify and add new resources to the website.
Resources available in the TASC resource library focus on prevention, tools for providers, examples of other programs and other topics as well. Please take a look at a sample of the resources below. Please share with those who can benefit from these resources and suggest any others to TASC you have found helpful.
Many more resources can be found on the
TASC website by searching for "substance use" or other key words in the search field.
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Weekly Rural Health Leadership Radio Program
A weekly radio program,
Rural Health Leadership Radio
, was launched a year ago to support rural health leaders to share stories and information about what is working, and what is not. To read the story of the program's development please visit an
article
promoting the resource from the National Organization of State Offices of Rural Health. Here are a few recent speakers:
- Maggie Elehwany, National Rural Health Association
- Marty Fattig, Nemaha County Hospital
- Bill Sexton, Crossing Rivers Health
- Dr. Connie Reimers-Hild, Rural Futures Institute at the University of Nebraska
- Nancy Zimmerman, Comanche County Hospital
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| Thank you to the Maine Flex Program and staff for a great Flex Program Site Visit. The Warming Hut is a welcome site to see when visiting Maine in January. |
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New & Updated Resources
The following resources on the TASC website are new or recently updated:
Author: Rural Health Value (RHV)
Central Peninsula Hospital, a rural hospital in Alaska, pursues high reliability patient care with the goal to eliminate all serious harm to patients and employees by 2020.
Author: Office of the National Coordinator for Health Information Technology (ONC)
The Patient Demographic Data Quality Framework (PDDQ) Framework addresses practical, proven activities needed to achieve and sustain effective management of an organization's patient demographic data. It incorporates best practices designed to help the organization establish, build, sustain and optimize effective data management across the patient demographic data lifecycle, from initial creation through updating, delivery, use and archiving or destruction. It also helps to increase an organization's appreciation for the criticality of its data assets by engaging staff in increasing capabilities and adopting disciplined practices.
Author: Substance Abuse and Mental Health Services Administration (SAMHSA)
This interactive flow chart with helpful resources will help to walk through questions to consider when integrating behavioral health into a primary care system.
Author: ONC
The Interoperability Standards Advisory (ISA) process represents the model by which ONC will coordinate the identification, assessment and public awareness of interoperability standards and implementation specifications that can be used by the health care industry to address specific interoperability needs including, but not limited to, interoperability for clinical, public health and research purposes.
Author: Centers for Disease Control and Prevention (CDC)
The Disaster Preparedness Budget Model is an Excel-based tool designed to assist health care executives in preparing their finances to withstand a large-scale public health emergency.
Author: National Center for Medical Legal Partnership
This screening tool that can be used by hospitals and health centers to systematically detect the health-harming social conditions that stand in their patients' way of good health.
New/Updated MBQIP Resources - are in the 'MBQIP Highlights' section above.
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Connect Peer to Peer in Flex Program Forum
Do you have a question, idea, success or challenge to share with your Flex Program peers? Don't miss the ongoing discussions on the
Flex Program Forum
.
Please note, you need to log in to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact
TASC.
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Flex Monitoring Team Resources
The Flex Monitoring Team has recently released two great resources we would like to bring to your attention.
Telehealth Webinar Recording
On this webinar, representatives from Hawaii and Nevada discuss their state Flex Program's efforts to launch and sustain a Project ECHO initiative within their respective states, including best practices and lessons learned.
HCAHPS Results for Critical Access Hospitals (CAHs), 2016
The Flex Monitoring Team has released reports of CAH performance and public reporting rates on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, utilizing data from calendar year 2016. Links to state-specific reports and a national summary report are now available.
Are your CAHs looking to change HCAHPS vendors? Please see the semi-annually updated
HCAHPS Vendor Directory
to support CAHs and other rural hospitals in choosing a HCAHPS vendor that can meet their needs.
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Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: TASC, SHIP, SRHT, Networks or Allied Health? Look no further!
TASC
- Fiscal Year 2016 PIMS Data Report Out
View a recorded webinar from the Federal Office of Rural Health Policy (FOHRP) about Performance Improvement and Measurement System (PIMS) data.
- Capturing Critical Access Hospital (CAH) Finance: Leveraging Data for CAH Financial Improvement
View a recorded Virtual Knowledge Group (VKG) webinar highlighting resources to support CAH financial improvement and the different ways states utilize tools and leverage relationships to improve financial performance within their CAHs. Additionally, understand the value of the data query tool within the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS), CAH Financial Indicator Reports (CAHFIR) and the use of subcontractors for financial improvement success.
Network
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Project Evaluation Plan Toolkit
Evaluation planning can guide a rural health network in collecting information on project activities, tracking progress towards objectives and identifying project improvement opportunities. In this webinar, the presenters will walk through an evaluation planning toolkit to support networks in developing evaluation plans.
SRHT
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National Rural Health Resource Center Blog
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Grow your Career: Save the Dates
Below is a list of upcoming events relevant to rural health:
February 1, 2018 2:00 p.m. - 3:00 p.m. Central Time
Understand the value of CAHMPAS and discuss different ways states are utilizing CAHMPAS. Learn best practices and tips for getting the most out of your CAHMPAS experience and hear about upcoming CAHMPAS developments
February 6-8, 2018 Washington, D.C.
Join the National Rural Health Association and an estimated 500 more rural health advocates from across the nation for the largest, and arguably the most important, rural advocacy even in the country.
February 7, 2018 12:00 p.m. - 1:00 p.m. Central Time
Discover new ideas to engage your patients and their families and create a more healing experience for them. Discuss strategies for staff accountability and remembering the true intention for creating a positive patient experience.
February 7, 2018 2:30 p.m. - 4:00 p.m. Central Time
A webinar from the Federal Office of Rural Health Policy (FORHP) and the Centers for Disease Control and Prevention (CDC) to provide additional information about completion of the National Health Safety Network (NHSN) Annual Facility Survey and its use in monitoring implementation of antibiotic stewardship programs. Anyone that was registered for the originally planned date of January 23rd will need to register again for the event.
February 21, 2018 2:00 p.m. - 3:00 p.m. Central Time
Rural health network leaders discussed the role of networks in a changing health care environment during a September 2017 summit. Their findings, including six common roles networks should play to support network members in the transition to population health will be presented in this webinar.
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