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Hello Everyone!
It was really great seeing all of the state Flex Programs and our partners last week in Maryland. A big thank you to the Federal Office of Rural Health Policy for hosting the Reverse Site Visit.
Please note in this edition of Rural Route the Regulatory Update section. There are a lot of current comment opportunities for regulation related to rural in programs that many of us support and care about. Did you know you can always find this full monthly CAH Regulatory Update on the TASC website?
There are also a lot of upcoming webinars relevant to Flex and CAHs including a SHIP webinar today, Virtual Knowledge Group on August 7 and TASC 90 on August 9.
Lastly, congratulations to all of the state Flex Programs that were recognized at the Reverse Site Visit for their hard work on MBQIP. And a special congratulations to Larry Baronner with the Pennsylvania Flex Program on receiving the 2017 Calico Leadership Award.
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:
- Ashley Wallace, Flex Coordinator in Kansas
We bid a fond farewell to:
- Jay Kennedy, Flex Coordinator in North Carolina
- Don Wood, State Office Director in Utah
- LaTonya Bynum, Data Analyst in Arkansas
We encourage you to keep your Flex staff contact information current by completing the new
contacts 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
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Dear Flex Coordinators,
It was great to see and talk to everyone at the Flex Reverse Site Visit (RSV) last week in Bethesda. Thank you for coming to Maryland on one of the hottest weeks of the year! Fortunately, we kept busy in the meeting rooms in the hotel basement so no one risked heat exhaustion. While down there we heard from Karen Madden about the strong Critical Access Hospital (CAH) Performance Improvement Network in New York, from Penny Black and Nicole Breton about measuring outcomes of their state Flex activities, from Lisa Carhuff and Meredith Guardino about collecting data to measure rural population health issues, and from many other Flex programs and partners. Thank you for sharing your knowledge and leadership stories. Do you have a great takeaway or a burning question from the RSV? Post it in the Flex Forum and let's have a discussion.
Coming up next will be the new Notices of Award (NOAs) for the Fiscal Year (FY) 2017 grant year starting September 1, 2017. Your project officer will be reaching out to schedule calls to review your NOA and any conditions it requires, for example, work plan or budget revisions.
The Performance Improvement and Measurement System (PIMS) will be open for FY 16 reporting starting on September 1, 2017. I am working on updated PIMS reporting instructions with new screenshots, but in the meantime, you can also review the PIMS Data Collection Tool and Webinar to make sure you are ready to report on your CAHs' participation in Flex activities.
Let me know if you are using the Flex Program Logic Model. I want it to be a living document and a thinking tool that we can all share.
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CAH Regulatory Update
Calendar Year (CY) 2018 Proposed Rule for Quality Payment Program (QPP)
On June 30, 2017, the Centers for Medicare and Medicaid Services (CMS) published a
proposed rule for the second year of the Medicare QPP. Under the QPP, eligible clinicians can participate via one of two tracks: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).
There are some major proposals of interest to rural providers. Please see the
CAH Regulatory Update for details. Comments are due by August 21, 2017. A
fact sheet is available on the CMS website for more information.
CY 2018 Proposed Rule for Physician Fee Schedule (PFS)
On July 13, 2017, CMS displayed a proposed rule to make annual updates to clinician payment under the Medicare PFS for 2018. Again, there are major proposals of interest to rural providers, details of which can be read in the full update online. Comments are due by September 11, 2017. A
fact sheet is available for more information. More information on the Medicare Diabetes Prevention Program (MDPP), which is part of the policies to be implemented in a program beginning in 2018, is available at this
link.
CY 2018 Proposed Rule for Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System
On July 20, 2017, CMS
displayed a rule proposing annual policy and payment changes for hospitals paid under the OPPS and ASCs paid under the ASC Payment System. The CY 2018 proposed rule continues to move OPPS away from separate fee schedule-like payments toward prospectively determined encounter-based payments that package multiple interrelated services. CMS intends this to encourage providers' efficiency and innovation as well as long-term cost containment.
For ASCs, the proposed rule would increase aggregate ASC payments for CY 2018 by $67 million compared to CY 2017, including annual update of 1.9 percent.
For the OPPS, major policy proposals of note for rural providers are detailed online and include impacts for CAHs such as
direct supervision requirement for outpatient therapeutic services, soliciting comments on 340B programs, among other items. Please see the
CAH Regulatory Update for more details. Comments are due by September 11, 2017. See the CMS
fact sheet for more information.
CY 2018 Proposed Rule for End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On July 5, 2017, CMS published a
proposed rule to update 2018 Medicare payment rates and policies for dialysis facilities. Proposals within the rule include an overall payment rate increase from CMS of $80 million, policies for coverage and payment for dialysis services furnished to individuals with acute kidney injury (AKI) by dialysis facilities, and updates to the ESRD Quality Incentive Program (QIP), including requirements for quality reporting and measurement and updating programmatic policies.
Of note for rural providers, CMS indicates that most rural dialysis facilities will experience a 0.6 percent payment increase; however, the 132 rural hospital-based dialysis facilities will experience an estimated 0.7 percent decrease in payments. Additionally, in payment year 2021, some of the changes to the ESRD QIP will result in estimated payment reductions for 325 ESRD small entity (rural) facilities (-0.19 percent).
The proposed rule also includes a Request for Information (RFI) to encourage continued feedback on improvements to the Medicare program including ideas for regulatory, sub-regulatory, policy, practice and procedural changes.
Comments are due by August 28, 2017. A
fact sheet
is available on the CMS website.
CMS Delays Rules for Home Health Agencies (HHA)
CMS has finalized its proposal to delay the effective date for the
revised home health conditions of participation (CoPs) from July 13, 2017, to January 13, 2018. HHAs, industry associations and individuals submitted 48 comment letters stating their need for more time to prepare for the implementation of the new rules, including potential changes to staffing and infrastructure. In response, CMS has added an additional six months thereby giving HHAs one year from the publication of the new rules to prepare. Once effective, these new rules for HHAs participating in Medicare and Medicaid will incorporate recent advances and practices that focus on patient-centered, data-driven and outcome-oriented care.
Of note for HHAs in rural areas facing physician shortages, the new conditions of participation allow licensed practical nurses acting within their state licensure and scope-of-practice requirements to receive verbal orders for home services.
Skilled Nursing Facilities (SNF) Now Eligible for Federal Communications Commission (FCC) Rural Health Care Program
On June 21, 2017, the FCC published a
final rule that adds SNFs to the list of health care providers eligible to participate in the
Rural Health Care Program as mandated by the
Rural Healthcare Connectivity Act of 2016. This change is effective June 21, 2017, and allows nearly 4,500 rural SNFs to receive funding to improve access to telecommunications and broadband services necessary for the provision of post-acute care. More information can also found at this
link.
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Baronner Recognized with 2017 Calico Leadership Award
Lawrence D. Baronner, Deputy Director at the Pennsylvania Offi
ce o
f Rural Health,was awarded the 2017 Calico Leadership Award at the State Flex Program Reverse Site Visit held July 19-20 in Bethesda, Maryland.
The Calico Leadership Award is presented annually by TASC, a program of the National Rural Health Resource Center, supported by the Health Resources and Services Administration's Federal Office of Rural Health Policy, to an outstanding rural health leader. The Calico Award was created in honor of long-time rural health leader, Dr. Forest Calico, for his life-long commitment to improving the quality of rural health. This year's award was presented to Baronner for his outstanding leadership, guidance and dedication towards improving the quality of health care in rural America.
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| Larry Baronner (left) receives the 2017 Calico Leadership Award, presented by Terry Hill. |
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HRSA Recognizes 10 States with Top Performing CAHs in Quality
The Health Resources and Services Administration (HRSA) is recognizing 10 states for outstanding quality performance of their CAHs in achieving the highest reporting rates and levels of improvement over the past year.
The 10 top performing states - Wisconsin, Maine, Utah, Minnesota, Illinois and Pennsylvania (tied), Michigan, Nebraska, Indiana and Massachusetts - built on their previous successes by investing FORHP funds into quality improvement projects and developing technical assistance resources that improve high quality care in their communities. States also work collaboratively with every CAH and their respective partners to share best practices and utilize data to drive quality improvement in their hospitals.
"Rural hospitals are key safety-net providers in their communities and it is important that we make every effort to provide the highest quality of care to individuals living in rural communities," said Dr. George Sigounas, HRSA Administrator. "Critical access hospitals may be limited in resources, but they have strong connections to their community and a commitment to quality care for every patient that is reflected in their effort to meet higher standards."
In 2011, FORHP, located within HRSA, created a program to promote high quality of care at rural hospitals with 25 beds or fewer. Low-volume hospitals participating in the Medicare Beneficiary Quality Improvement Project (MBQIP) voluntarily report on a set of quality measures relevant to the care they provide, share data, and take on quality improvement initiatives. Currently, 96 percent of the 1,340 CAHs in the U.S. are reporting rural-relevant quality measures.
For more information:
Federal Office of Rural Health Policy
Medicare Beneficiary Quality Improvement Program
Critical Access Hospitals
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| The 10 top performing state flex Program representatives pictured with FORHP staff and HRSA Administrator, Dr. George Sigounas. Pictured from left to right: Yvonne Chow (FORHP), Kristi Martinsent (FORHP). Dr. George Sigounas (HRSA), Daniel Prokop (IN), Ronnie Rom (MA), Nancy Jo Hansen (NE), Angie Charlet (IL), Crystal Barter (MI), Kathryn Miller (WI), Judy Bergh (MN), Lannette Johnston (PA), Matt McCullough (UT) and Nicole Breton (ME). |
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MBQIP Highlights & Resources
As a reminder, please send your MBQIP questions to the
tasc@ruralcenter.org e-mail address. TASC will ensure your question reaches the best person to answer your question.
MBQIP Data Reporting Reminders - UPDATED
Upcoming Data Submission Deadlines:
July 31, 2017
Emergency Department Transfer Communication (EDTC):
- Patients seen Q2 2017 (April, May, June)
- Submission process directed by state Flex Program
August 1, 2017
CMS Population and Sampling (optional)*
- Patients seen Q1 2017 (January, February, March)
- CMS Hospital Outpatient Reporting Specifications Manual Version 10.0a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 1.15
August 15, 2017
CMS Inpatient Measures:
- Patients seen Q1 2017 (January, February, March)
- CMS Hospital Inpatient Reporting Specifications Manual version 5.2a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 4.19.1
*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.
Submission of Outpatient Population and Sampling data through the grid in the QualityNet Secure Portal is currently not functional. CMS has offered instructions on a work-around process for that submission using an XML file. Information on that process can be found on the
TASC website. CAHs with zero (0) cases to submit in one or more of the outpatient measure sets are encouraged to use the work-around XML submission process for their Outpatient Population and Sampling data. This is only for outpatient; inpatient population and sampling can be submitted through the grid as usual.
Resources
This document provides guidance on practical strategies to implement antibiotic stewardship programs in small and critical access hospitals. It was developed as a collaboration between the Centers for Disease Control and Prevention (CDC), American Hospital Association (AHA), FORHP and The Pew Charitable Trusts. The suggestions provided are based on discussions with staff in small and critical access hospitals, several of which have implemented all of the CDC Core Elements.
Author: Centers for Disease Control and Prevention
This document summarizes core elements of successful hospital antibiotic stewardship programs (ASP). It complements existing guidelines on ASPs from organizations including the Infectious Diseases Society of America in conjunction with the Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists and The Joint Commission.
Author: Centers for Disease Control and Prevention
This checklist should be used to systematically assess key elements and actions to ensure optimal antibiotic prescribing and limit overuse and misuse of antibiotics in hospitals. CDC recommends that all hospitals implement an antibiotic stewardship program. Facilities using this checklist should involve one or more knowledgeable staff to determine if the principles and actions to improve antibiotic use are in place. The elements in the checklist have been shown in previous studies to be helpful in improving antibiotic use though not all of the elements might be feasible in all hospitals.
Ask Robyn - Quarterly Open Office Hour CAlls for Data Abstractors
Scheduled approximately one month before data submission deadlines each quarter, RQITA Quality Data Specialist Robyn Carlson will be offering open office hour calls to respond to MBQIP data abstraction questions
.
2017 dates:
- September 20, 2:00-3:00 p.m. CT
Note: registration is required, please follow this
link for details.
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.
MBQIP Virtual Knowledge Groups
Rural Quality Improvement Technical Assistance (RQITA) and TASC have teamed up to host MBQIP virtual knowledge group (VKG) calls/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
August 17, 2017, 2:00 p.m. - 3:30 p.m. Central Time. More information will be sent to the appropriate email lists prior to the call. Contact
Jodi Winters at Stratis Health with any questions or for access to the recordings of previous VKG webinars.
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Additional State Flex Programs Recognized for MBQIP Success
The following state Flex Programs were recognized at the 2017 Flex Program Reverse Site Visit for success in MBQIP. Congratulations!
Most Improved Across All Domains
This award indicates exemplary quality reporting and performance improvement in MBQIP As indicated by the largest change in rankings in reporting, performance, and overall rankings across all domains from data submitted between Q2 2014 - Q1 2015 (EDTC Q1 - Q4 2015) to this year's rankings from data submitted between Q1 2015 - Q4 2015 (EDTC Q1 - Q4 2016).
- Reporting: Georgia (+17 change)
- Performance: South Dakota (+21 change)
- Overall: Utah (+20 change)
Spirit Award
This award is presented to the Flex Coordinator that exemplifies the collaborative and innovative spirit of the MBQIP program.
- Oklahoma - Team | With the recent retirement of the former state Flex Coordinator, a team of three (Corie Kaiser, Pete Walton and Lara Brooks) has made a real difference in the use of MBQIP data in the past year, including maps in their NCC. They are in consistent communication with their project officer, Owmy Bouloute, and there is a palpable ambition to expand the quality improvement program in Oklahoma in ways that may not have been considered before
- Washington - Danielle Messier | Danielle jumped in as a new quality coordinator, working with RQITA to learn a lot through enhanced TA, and proactively assessing her CAHs' capacity to engage in quality improvement around MBQIP measures. She also maintain a MBQIP desk manual for new CAH staff and created a simplified EDTC abstraction tool for struggling CAHs with hints, pop-ups and interactive features
- Nevada - John Packham | Nominated by RQITA, John is a consistent advocate, cheerleader and positive voice for MBQIP, particularly in his role of experienced Flex Program Coordinator and mentor to other Flex program staff (he co-Chairs the NOSORH Flex Committee). Several partners are engaged in MBQIP implementation in Nevada, and they have seen strong improvement over the past two years
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Kenny Doppenberg, South Dakota, is recognized for performance improvement in MBQIP reporting. Karla Weng, RQITA, (background) aided in presenting the awards at the 2017 Flex Program Reverse Site Visit.
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2017 Flex Program Reverse Site Visit
Thank you to all that attended the 2017 Flex Program Reverse Site Visit last week in Bethesda, Maryland. It was wonderful to see our colleagues, learn new content, share our ideas and successes, problem solve and network.
Thank you to all of the state Flex Program staff that spoke at the event - we appreciate you!
Presentations from the event can be found on the
TASC website. If you have questions on the content, please reach out to TASC or directly to the presenter.
Please also take a few moments to
complete the electronic Post-Conference Assessment that you should have received in your email (please check your spam filter). The assessment allows TASC to determine knowledge transfer and satisfaction for the event. Please respond to the assessment by Tuesday, August 1.
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Flex Program Logic Model
At the 2017 Flex Program Reverse Site Visit last week Sarah Young from FORHP introduced a
Flex Program Logic Model. Please take time to review the model and send any thoughts or comments to Sarah at
syoung2@hrsa.gov
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SHIP Coordinator Technical Assistance Webinar - July 27
This webinar will feature a state coordinator of the Small Rural Hospital Improvement Grant Program (SHIP) to discuss collaboration efforts involved with pooling SHIP funds for a shared project. The presentation will also include a summary of program recommendations submitted as part of the FY 2017 Non-Competing Continuation progress reports, along with an opportunity for SHIP coordinators to provide additional feedback and insights.
Speakers will include Bridget Ware, FORHP, Shellie Smith, Alaska Department of Health and Social Services and the SHIP technical assistance team at the National Rural Health Resource Center
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TASC is wrapping up final content and collecting your feedback, suggestions and determining knowledge gained from the Flex Program Reverse Site Visit last week. Other items in development and to be released by the end of August include:
- Virtual Knowledge Group Webinar on August 7 on Crucial Conversations
- TASC 90 Webinar on August 9 - Preparing for the New Program Year
- Release of the semi-annual update of the HCAHPS Vendor Directory
- Release of an update to the Sliding Fee Scale Discount Guide for Critical Access Hospitals that includes information on the National Health Service Corp and rural health clinics (RHCs)
- Release of a cybersecurity tool and checklist for small rural hospitals, CAHs and RHCs at the end of August
Please take a peek at the new
TASC website and website for the
National Rural Health Resource Center! We are updating our taxonomy of how resources are described, changing the look to improve navigation and available information and developing topic collections so you can easily find related resources. The changes will be incremental over time but we hope they will improve the user experience. What do you think of it? Please share your comments and feedback on the
website or by
emailing TASC.
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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Flex Virtual Knowledge Group Webinar - August 7
Please save the date for the below VKG webinars
. Calendar appointments will also be distributed:
This VKG webinar will focus on the book Crucial Conversations: Tools for Talking When Stakes are High, by Kerry Patterson, Joseph Grenny, Ron McMillian and Al Switzler. This text provides suggestions for skills and approaches that help identify and hold crucial conversations. There are other approaches too and in our VKG conversations, we will talk about how we approach difficult conversations and include some best practices and general facilitation tips that will help.
We are pleased to continue a series of Virtual Knowledge Group (VKG) webinars for state Flex Program staff for the current Flex program year. VKG webinars are supported by FORHP and coordinated by TASC.
VKG webinars are intended to provide a forum to state Flex Programs for peer learning to share successes, discuss challenges and brainstorm strategies for improvement and Flex Program excellence. A variety of topics focusing on the Flex Program will be discussed on the webinars, focusing on a conversation instead of a presentation. In some instances, subject matter experts and/or state Flex Programs will be identified in advance to share their stories, expertise or experience. An agenda will be distributed prior to each webinar to allow state Flex Program personnel and/or appropriate subcontractors an opportunity to determine whether the topics will align with their needs. The VKG webinars will be recorded with playback made available in the Flex Program Forum. The intended audience for the VKGs include state Flex Program Directors, Coordinators or other Flex personnel, including Flex Program subcontractors working on implementing Flex-related activities.
Please note that the MBQIP VKG calls are coordinated by RQITA.
If you have any questions about the VKGs, please contact
Bridget Hart
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Save the Date: TASC 90 - August 9
 Please save the date for a TASC 90 webinar on
Wednesday, August 9, 2017 from
2:00 pm - 3:30 pm Central Time. The topic for the webinar will be
Preparing for the New Program Year. With the analogy of back to school preparations, there are important items to do to close out the current program year and start the new one. Is your pencil case in order? Do you know where your locker is? Where is the resource room? Of course the descriptions will be relevant to state Flex Programs, but we look forward to sharing our best suggestions with you.
The webinar will also include updates from TASC, the Flex Monitoring Team, RQITA and FORHP, to include both the Flex program and policies impacting CAHs. This event is supported by FORHP and coordinated by TASC, a program of the National Rural Health Resource Center. A detailed agenda will follow later this month.
Registration for this TASC 90 webinar is not required; however the intended audience for the event is State Office of Rural Health Directors and Flex Program Coordinators. The recording, not the live event, may be shared with your rural health contacts.
Topic: Preparing for the Program Year
Date: Wednesday, August 9, 2017
Time: 12:00 p.m. PT | 1:00 p.m. MT | 2:00 p.m. CT | 3:00 p.m. ET
Duration: 90 minutes
Audience: State Office of Rural Health Directors and Flex Coordinators
This webinar will be recorded with playback made available on the
TASC website.
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| Keynote speaker, Scott Wordelman, describing the need for state Flex Programs to lead through transitions at the 2017 Flex Program Revers Site Visit. |
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Webinar & Tool: CAH Pro Forma for Shared Savings
Health care is on a path to value, regardless of health care reform uncertainties. Thus, critical access hospitals need to understand accountable care, especially if considering joining an ACO. This webinar will present a new Excel-based tool developed by the Rural Health Value team and Premier, Inc. The
Critical Access Hospital Pro Forma for Shared Savings assesses the financial implications of joining a Medicare Shared Savings Plan Accountable Care Organization (ACO). The publicly available, free tool highlights five-year revenue and expense forecasts financial projections that compare current state to Medicare ACO participation and an easy to understand table and chart summary outputs, including hospital and physician financial projections.
Webinar speakers:
- Clint MacKinney, MD, MS, Clinical Associate Professor in the Department of Health Management and Policy at the College of Public Health, University of Iowa and Deputy Director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy and Analysis
- Jane Jerzak, CPA, RN, Partner, Wipfli LLP
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Drive Time to Emergency Care in Wisconsin Map
 The Wisconsin Office of Rural Health has created
The Drive Time to Emergency Care map, which depicts all hospital-based and freestanding emergency rooms that can be reached in 10, 20 and 30-minutes from within Wisconsin. The map also includes an estimate of the Wisconsin population that lives within each of those drive times.
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Rural Tobacco Control and Prevention Toolkit
 This new
toolkit, developed by the NORC Walsh Center for Rural Health Analysis, provides information, strategies and resources to help rural communities implement tobacco control and prevention programs. The toolkit offers program models and examples, and information on how to implement, evaluate and sustain a program in your community and disseminate program results.
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Planning Resources for the Solar Eclipse
The US Department of Health and Human Services (HHS) Office for the Assistance Secretary for Preparedness & Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) has released a
resource for emergency health care planners and providers to prepare for and address response concerns related to the 2017 solar eclipse (and unplanned and planned mass gatherings in rural and urban areas). Resources in sections I through V are specific to the eclipse event; the rest of the sections include resources related to planned mass gatherings.
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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 and to access the content, please visit an
article promoting the resource from the National Organization of State Offices of Rural Health. To name just a few, previous and upcoming speakers include names you may be familiar with include:
- John Barnas, Michigan Center for Rural Health
- Bill Jolley, Tennessee Hospital Association
- Lynn Barr, Caravan Health
- John Gill, National Association of Rural Health Clinics
- Andy Fosmire, Oklahoma Hospital Association
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Quality Payment Program Resources for Small, Rural and Underserved Practices
Have you been looking for Quality Payment Program (QPP) resources relevant to rural? We've compiled a series of eight resources and webinars developed by CMS into one location. Please share this
bundle with your rural contacts.
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| Danielle Messier, Washington, was recognized with the Spirit Award for her contributions to the state's MBQIP efforts at the 2017 Flex Program Reverse Site Visit. Pictured left to right are Karla Weng, RQITA, Danielle Messier and Sarah Young, FORHP. |
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New Rural Health Research
CMS Hospital Quality Star Rating: For 762 Rural Hospitals, No Stars is the Problem
The purpose of this
brief is to look more closely at the characteristics of rural hospitals with and without CMS Hospital Quality Star Ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.
Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse
Utilizes data from the Healthcare Cost and Utilization Project's (HCUP) State Emergency Department Databases (SEDD) for seven states. Researchers explore and describe in this
policy brief the use of the emergency department for mental health and substance abuse among urban, large rural, small rural and isolated small rural residents.
Use of the Emergency Department for Mental Health and Substance Abuse among Women
This
study identifies trends among women in rural and urban communities who utilize the emergency department for mental health and substance abuse. The information can be used to help communities provide more relevant, appropriate and less costly care.
After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
A new
paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits among Medicare Beneficiaries
This
journal article uses national representative 2007 to 2010 Medicare data to examine the relationship between rural health clinic (RHC) use and potentially preventable hospitalizations and emergency department visits. RHC use was associated with an increase in both preventable hospitalizations and emergency department visits among all Medicare enrollees, regardless of their reason for eligibility.
Knowledge of Health Insurance Concepts and the Affordable Care Act Among Rural Residents
Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan and optimal health care services. To fully benefit from policy efforts to improve health insurance access, rural residents must have the ability to select the plan that best meets their health care needs. However, a higher proportion of rural residents possess characteristics that may put them at risk of lower health insurance literacy, including lower incomes and educational attainment, less experience with private insurance and historically higher uninsured rates. Using Health Reform Monitoring Survey data from 2013 and 2014, this
study examined whether rural and urban residents demonstrated different knowledge and/or use of the Affordable Care Act Marketplace and subsidies; enrollment sources; the health insurance mandate and health insurance terms and concepts. The study also examined whether knowledge and use changed between the fourth quarters of 2013 and 2014.
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New & Updated Resources
The following resources on the TASC website are new or recently updated:
Author: Centers for Medicare and Medicaid Services (CMS), Medicare Learning Network (MLN)
Learn about integrating behavioral health with primary care services, the Psychiatric Collaborative Care Model (CoCM) and how to bill for behavioral health integration services.
Author: Centers for Medicare and Medicaid Services (CMS)
Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients. The Centers for Medicare & Medicaid Services (CMS) recognizes CCM takes time and effort. CMS established separate payment under billing codes for the additional time and resources you spend to provide the between-appointment help many of your Medicare and dual eligible (Medicare and Medicaid) patients need to stay on track with their treatments and plan for better health. CCM services may be billed by:
- Hospitals, including CAHs
- Rural health clinics (RHCs)
- Federally qualified health center (FQHCs)
- Physicians and certain non-physician practitioners (physician assistants, clinical nurse specialists, nurse practitioners and certified nurse midwives)
Data Sources & Tools Relevant to Rural Health
Author: Rural Health Information Hub (RHIhub)
This comprehensive list includes data sources focused on health care services, health status, demographics and social determinants of health. For each source, it identifies the topics covered, ease of use, geographic level of data and update frequency.
Author: Rural Health Information Hub (RHIhub)
This guide will help locate and accurately use statistics and data in order to understand rural health needs, describe rural/urban disparities, communicate rural health needs and inform decision-making related to service delivery and policy.
Author: American Hospital Association (AHA)
Case studies in this guide highlight the innovative strategies and programs of several hospitals and health care systems to reduce food insecurity in their communities. This guide is one in a series of guides on how hospitals can address the determinants of health such as food, housing and education to improve the environment where people live, work and play.
Author: Rural Health Information Hub (RHIhub)
This toolkit provides rural communities with the information, resources and materials they need to develop a community health program in a rural community. Each of the toolkit's six modules contains information that communities can apply to develop a rural health program, regardless of the specific health topic the program addresses.
Author: Rural Health Information Hub (RHIhub)
The Community Health Workers (CHW) Toolkit is designed to help evaluate opportunities for developing a CHW program and provide resources and best practices developed by successful CHW programs. The toolkit is made up of eight modules. Each module concentrates on different aspects of CHW programs and include resources for use in developing a program.
Author: Rural Health Information Hub (RHIhub)
The purpose of this toolkit is to provide resources, strategies and examples to communities who are considering developing a new or expanding an existing health network or coalition. This toolkit consists of seven modules. Each module contains useful information and links that provide connections to resources and materials that can help create or expand networks or coalitions.
Author: Rural Health Information Hub (RHIhub)
This toolkit provides evidence-based examples, promising models, program best practices and resources that can be used to implement substance abuse prevention and treatment programs. There are seven modules in the toolkit and each module contains resources and information to develop, implement, evaluate and sustain rural programs to prevent and treat substance abuse.
Author: Rural Health Information Hub (RHIhub)
This toolkit identifies evidence-based and promising models and resources that will benefit rural communities seeking to implement services integration programs. The toolkit is made up of seven modules with each module including different aspects of services integration programs and resources for use in developing programs.
Author: Centers for Medicare and Medicaid Services (CMS)
The Centers for Medicare and Medicaid Services offer support to promote successful participation in the Quality Payment Program (QPP), in either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM) track. This support is from on-the-ground organizations and resources.
New/Updated MBQIP Resources - are now 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 login to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact
TASC.
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Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: TASC, SHIP, SRHT or Networks? Look no further!
TASC
Learning objectives include: Review the either strategies identified at the Summit to assist rural hospitals through the transition, hear a research update on CAHs deploying the strategies identified in the 2016 Financial Leadership Summit, discover experiences from the field from a subject matter expert advising CAHs on these strategies, learn the approach and identified outcomes of a state flex program that is addressing the recommended strategies with their CAHs.
This webinar provided a review of EMS related activities that are currently funded in this three-year Flex grant cycle.
Learning objectives include: Learn the key features of the Population Health Portal, discover how a state Flex Program can leverage the resources, assessment and data scenarios and understand how CAHs can use claims data to support population health management.
SHIP
This webinar discusses a recent Lean project conducted at a critical access hospital in Arizona and how similar quality improvement initiatives can be undertaken using SHIP funding.
SRHT
As CAHs and small rural hospitals evaluate whether to participate in an alternative payment model (APM) as an option under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for their medical providers, it is important for hospital leadership to evaluate the APM model from a business plan perspective. The APM model requires hospital and clinician integration which will impact reimbursement and how care is coordinated and managed in the both the hospital and practice setting. Pat Schou, Executive Director for the Illinois Rural Community Care Organization (IRCCO), a statewide rural accountable care organization (ACO), discusses the financial strategies IRCCO has undertaken to prepare hospitals and their medical providers for clinical integration. She shares how they measure the return on investment for the ACO as well as for the hospital and medical provider. Ms. Schou explains the advantages and disadvantages of an organization considering becoming a part of an APM.
The introduction of MACRA marked a major change in physician reimbursement methodology. Prior to this legislation service, volume drove physician revenue. Value has replaced volume as the key driver of revenue. Dr. Davis explores the impact value-based reimbursement, MIPS and APMs have on physicians. The participation choices and the effect of employment in a fee-for-service (FFS) environment, rural health clinic (RHCs) and federally qualified rural health clinics (FQHCs) are discussed.
Show-Me ECHO uses videoconferencing technology to bring together physician specialists and primary care providers to collaborate in a case-based learning environment to develop advanced clinical skills and best practices. Learn how to build an ECHO project in your rural community. Understand the benefits and challenges of the necessary expertise and staffing needed to operate ECHO projects.
Behavioral Health and Virtual Care leaders discuss best practices and lessons learned while providing insights on how to implement and scale a Tele-Behavioral Health Program at a tertiary care center across a system of small, rural hospitals and clinics.
Network
As networks or partners move forward in care coordination, it is important to understand how technology can improve communication, reporting and outcomes for the population. This webinar features a panel of rural health network leaders who share their experiences in selecting and implementing technology that supports care coordination efforts.
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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:
Technical Assistance and Services Center (TASC)
Monday, August 7, 2017 - 2:00 p.m. Central Time
TASC 90 - Preparing for the New Program Year
Wednsday, August 9, 2017 - 2:00 p.m. Central Time
Flex Program Workshop
Tuesday, October 17 - Thursday, October 18, 2017 Duluth, Minnesota
SHIP
Thursday, July 27, 2017 - 1:00 p.m. Central Time
View upcoming rural events
by month, s
tate or keyword search.
Wednesday, September 6 - Thursday, September 7, 2017 Savannah, Georgia
Tuesday, September 26 - Friday, September 29, 2017 Kansas City, Missouri
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