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Rural Route
 
February 22, 2017  
In this Issue
Welcome and Farewell
CAH Recognition
Notes from FORHP
CAH Regulatory Update
MBQIP Highlights
MBQIP Resource List
MBQIP Quality Measure Trends
TASC Tasks
Flex Program VKGs
New & Updated Resources
Health-Related Behaviors Research
Flex Forum
Rural Research
Webinar Playbacks and Event Materials
The Center Blog
Save the Dates
Social Media
TASC Website Quick Links

TASC Home

Events

Flex Program Forum

MBQIP

Resource Library

Staff

State Flex Profiles

On Center Blog

Quick Links
FMT
Hello Everyone!

Apparently Punxsutawney Phil has predicted more winter!! So in the spirit of the season we've posted some beautiful winter pictures below. Please send me any pictures you happen to take on your travels.

On February 15, we hosted a TASC 90 webinar with updates from the Technical Assistance and Services Center (TASC), the Flex Monitoring Team (FMT) and Flex Program and policy updates for critical access hospitals (CAHs) from the Federal Office of Rural Health Policy (FORHP). Learning objectives include: learn the key features of the Population Health Portal, including a readiness assessment, resources and data scenarios to support an organization's journey to population health, discover how a state Flex Program can leverage the resources, assessment and data scenarios in the Population Health Portal to support their CAHs and develop relevant Flex Program activities based on CAHs' needs and understand how CAHs can use claims data to support population health management including resources available in the Population Health Portal.

Below you will see an article dedicated to recognizing the success of our third CAH Recognition Certificate recipient. Please join me in congratulating Hansford County Hospital District in Texas for their efforts. 


Feel free to send any pictures you happen to take along your travels. 

Until next time,

Caleb Siem, MH
Program Specialist
Technical Assistance and Services Center (TASC)
Welcome and Farewell
 
Welcome to: 
  • Daniel Prokop, Flex & SHIP Coordinator, Ohio
  • Shannon Chambers, Director of Provider Solutions, South Carolina 
  • Kevin Fleming, Rural Project Manager, Kentucky
  • Abigail Garcia, SORH Manager, Indiana

We bid  a very fond farewell to Kathleen Spencer, Librarian/Information Specialist at RHIhub, who is retiring on March 3. Kathleen worked to support rural health for over 13 years and worked behind the scenes on many TA requests and resources developed in tandem with TASC and the National Rural Health Resource Center. We thank her and wish her the very best in retirement.


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. 
Jonathan Bailey, CEO Hansford County Hospital District, accepting the Certificate of Recognition from Julie Ketelsen, Rural Health Specialist, Texas
CAH Recognition - Emergency Medical Services Innovation

Congratulations to Hansford County Hospital District (HCHD) in Spearman, Texas, our third recipient of the National Rural Health Resource Center's Critical Access Hospital (CAH) Recognition Certificate for demonstrating innovation in the area of emergency medical services (EMS). Julie Ketelson, Rural Health Specialist with the Texas State Flex Program, nominated Hansford County Hospital for their efforts and leadership.

HCHD in Spearman, Texas has collaborated with Northwest Central Texas EMS (NWCT EMS) Resources, Inc. to create a program that arms registered nurses (RNs) with the knowledge and training of an emergency medical technician (EMT). The program consists of an intense 24 hour EMT course. Once the program is complete RNs are eligible to sit for the National Registry of EMT Certification examination. During the pilot program, six Hansford County Hospital nurses and two nurses from surrounding communities attended. While the nurses who attended the program understood the time commitment, their volunteer participation was based on their belief of the importance of EMS and the impact it has on saving lives. 

The goal of the program, "to provide a solution to the EMS problem in West Texas", is based on research from Texas Tech University which concluded that "EMS in rural West Texas is limited by funding, aging or lack of equipment, distances, personnel, and failing road systems." With expected outcomes of reducing emergency room (ER) wait times, better utilization of local EMS due to an increase  in staffing and a decrease in the amount of health care costs by utilizing ground transportation instead of air transportation; the return on investment will be well worth the cost of the class.

EMS in West Texas has a history of collaboration and mutual support across city, county and state boundaries. Prior to the pilot program in Spearman, HCHD and NWCT EMS Resources met with representatives from Department of State Health Services, Amarillo College, local CAHs, local EMS directors, Baylor College of Medicine and the Panhandle Regional Advisory Council. HCHD expects to continue this project and collaborate with the other entities that were involved from the beginning. 

Measuring the knowledge of the program participants and program effectiveness is crucial in order to replicate the program in other CAHs. Faculty from Baylor College of Medicine administered a pre-test to class participants and will administer a post-test after participants have taken the National Registry of EMT Certification examination. In order to test the effectiveness  of the program, HCHD will review the amount of ER wait times every three months.    

Jonathan Bailey, MHA, Hansford County Hospital District (HCHD) Chief Executive Officer said, "the RN to Basic class is just one example of the innovative strategies rural health care providers must utilize to meet our unique staffing challenges. HCHD is extremely honored to receive this award and we feel it shows our commitment to providing quality health care to our patients and our community."  
Notes from FORHP
Sarah Young, FORHP

Dear Flex Coordinators,
I got a personal reminder of the importance of rural health care and the work we do earlier this month. My dad, who lives in rural Eastern Oregon near Idaho, had a badly infected gallbladder that required urgent surgery to remove. Fortunately, I was able to make a short-notice trip to Boise so I could meet my parents at the hospital before Dad's discharge and help him for the first days back home. Large incision surgery is painful enough (his gallbladder was too inflamed for laparoscopic removal), but as you know everything is more complicated when you face a two-hour drive to get home and then another two-hour drive for a follow up visit with your surgeon. We were lucky and didn't have any snowstorms the week I was home so at least distance wasn't compounded  by bad roads .
It's been four weeks since the surgery now and Dad is feeling much better. I'm still thankful to the volunteer EMS service that transported him to the ER, to the CAH staff who diagnosed his abdominal pain and referred him to a hospital with an on-call surgeon that night, and to the Idaho surgeon who takes call at an Oregon hospital owned by a separate system to ensure that patients can get the treatment they need. A final thank you to all of you who work to maintain these rural health systems so people like my dad can get health care when they need it.
We had good presentations about population health data that is available for Flex Programs and CAHs from John Gale, Sally Buck and David Marc during the TASC 90 webinar on February 15. If you weren't able to join the live call you can always watch or listen to the recording.
On the grant operations side I'll make one last reminder: any carryover request must be in the Electronic Handbook (EHB) no later than March 1. We will reject any new requests after that date. The next program-wide milestone will be the Non Competing Continuation (NCC). I expect the instructions for that to be released in EHB the week of March 20. Of course you will have 60 days to complete the NCC report after it's released. 
As always, reach out to your project officer when you have grant questions. We also like to hear success stories so let us know when you have a great result from a project you've invested in.
Flex Program Coordinator
CAH Regulatory Update

Fact Sheet: New Accountable Care Organization Model Opportunity: Medicare ACO Track 1+ Model
The Centers for Medicare & Medicaid Services (CMS) released additional details on the Medicare Accountable Care Organization (ACO) Track 1+ model, which is one in a series of Innovation Center initiatives that will expand opportunities for clinicians to participate in Advanced Alternative Payment Models (APMs) under MACRA. This ACO model incorporates more downside risk than is currently present in Track 1 of the Medicare Shared Savings Program and is designed to help small practices move toward performance-based risk and to allow small hospitals, including rural to participate. 

Proposed Rule: 2018 Medicare Advantage and Part D Advance Notice and Draft Call Letter
CMS announced proposed updates to the Medicare Advantage (MA) and Part D prescription drug program, opening a 30-day public comment period.

Request for Letters of Intent for two new Beneficiary Engagement and Incentive Models
CMS is seeking provider participation in two new models from the CMS Innovation Center taht will increase patient engagement in care decisions by putting more information in the hands of Medicare beneficiaries. The Direct Decision Support (DDS) Model under the Beneficiary Engagement Model (BEI) will test whether engaging beneficiaries outside the clinical setting will inform and empower their health care decisions. CMS will partner with up to seven Decision Support Organizations (DSOs) to provide direct decision support to at least 100,000 Medicare beneficiaries in a geographic region (e.g. state and/or region). Also under BEI, the Shared Decision Making (SDM) Mode l will test integrating a structured four-step shared decision-making process into the clinical practice of Medicare Shared Savings Program (MSSP) and Next Generation Accountable Care Organizations (ACOs). Letters of Intent for both models are due March 5.

Medicare and Medicaid Conditions of Participation for Home Health Agencies
On January 13, CMS published its final rule (82 FR 4504) updating the conditions home health agencies (HHAs) must meet to participate in Medicare and Medicaid. Of note for HHAs in rural areas disproportionately affected by physician shortages, CMS revised its policy to allow licensed practical nurses (LPNs) acting within their state licensure requirements and state scope of practice laws to receive verbal orders for home health services, although statute requires taht only physicians establish the home health plan of care for Medicare beneficiaries. The final rule takes effect July 13. For more information, see the CMS press release. In response to 199 comments from home health providers, industry associations, and patient advocates, the rule finalizes several changes to the conditions of participation first proposed in October 2014 ( 79 FR 61163)

Extension of Data and Meaningful Use Deadlines
CMS extended the attestation deadline for hospitals and eligible physicians participating in the Medicare Electronic Health Records (EHR) Incentive Program (i.e., "Meaningful Use") to March 13. Hospitals participating in the program must attest to meeting 2016 requirements to avoid a 2018 payment adjustment. The new March 13 deadline for Meaningful Use attestation aligns with the March 13 deadline fro hospitals and critical access hospitals (CAHs) participating in the Hospital Inpatient Quality Reporting (IQR) or Meaningful Use programs to submit electronic Clinical Quality Measure (eCQM) data for calendar year 2016.

CMS Proposes Changes for the 2018 Marketplace
On February 15, CMS released a proposed rule that would revise provisions in the Benefit and Payment Parameters final rule and Letter to Issuers for the 2018 benefit year to promote market stability in the Health Insurance Marketplace. Comments are due for this proposed rule by March 7, 2017. For more information visit:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-02-15.html

CMS Launches Technical Assistance to Help Small and Rural Practices Succeed in the Quality Payment Program
Late last year, CMS finalized the details of the Quality Payment Program. This program is a new approach to Medicare clinician payment with two tracks: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS). On February 17, CMS announced the award of up to $100 million to help clinicians in individual or small group practices of 15 clinicians or fewer succeed in the Quality Payment Program.

OIG Revisions to the Safe Harbors Under the Anti-Kickback Statute - Final Rule
The Office of the Inspector General for the US Department of Health & Human Services recently issued a final rule that eases the ability to provide free or discounted transportation services for health care. Under the rule, federal health care programs arranging service from local transportation providers are granted a " safe harbor" exemption from the anti-kickback statute, which prohibits offering, soliciting or accepting of any type remuneration for referral to a federal health care program business.

For more details on any of the above updates and the complete regulatory update please visit the Regulatory Updates Webpage .
MBQIP Highlights & Resources
MBQIP highlighted

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
 
As you may be aware, there have been a variety of issues with the QualityNet Warehouse related to submission of Q3 2016 data for both the Centers for Medicare and Medicaid (CMS) inpatient and outpatient measures. CMS has delayed deadlines, and has been shutting down access to the database periodically in order to do maintenance. The deadline for outpatient measures and population and sampling data had been extended until February 15, the deadline for inpatient measures has been extended until February 24, and the deadline for Hospital Acquired Infection (HAI) measures was extended until March 15 (none of the HAI measures are required by MBQIP, but many CAHs do report them). Due to all these changes, and to help ensure we are providing the most accurate information, there will be a delayed release of the MBQIP reporting reminders document for a couple weeks. 

Quality Improvement Implementation Guide and Toolkit for Critical Access Hospitals NEW
This guide and toolkit offers strategies and resources to help CAH staff organize and support efforts to implement best practices for quality improvement.

Internal Monitoring Tool  
A simple Excel-based tool to assist CAHs with tracking and displaying real time data for MBQIP and other quality and patient safety measures to support internal improvement efforts. 

Healthcare Professional Flu Measure (OP-27) Webinar 
This webinar provides an overview of the Healthcare Professional Flu measure (OP-27), including how to sign up for an account through the National Safety Healthcare Network (NHSN), the measure submission process and available quality improvement support.

Leadership Rounding

A common strategy for improving quality, patient safety and employee engagement A couple of resources on implementation include

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.

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 April 20, 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.

Contact  tasc@ruralcenter.org  with your inquiries, questions and comments related to MBQIP and/or resources.
MBQIP Resource List

Bookmark this now!

RQITA has compiled the best-of-the-best overview and key resources for MBQIP into one Resource List for your quick and easy access.

The MBQIP Resource List can be accessed from the main MBQIP web page.
HCAHPS Results for CAHs, 2015

The Flex Monitoring Team (FMT) has released reports of CAH performance and reporting rates on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, utilizing data from calendar year 2015.

For more information about this study, please contact Michelle Casey of the Flex Monitoring Team.
  
Photo courtesy of Marilyn Grafstrom_ Rural Health Liason_ Stratis Health
Photo courtesy of Marilyn Grafstrom, Rural Health Liaison, Stratis Health
wire-bound-pad.jpg
TASC Tasks

TASC has been busy working on the following items for state Flex Programs, CAHs and other partners:
  • Flex Program Fundamentals Guide - updated online and mailed to each state Flex Program on February. If your office does not receive a copy by February 28, please email Bridget Hart
  • State Flex Profiles - 2017 updates were published online in early February
  • Virtual Knowledge Group (VKG) webinars - the next webinar will be March 6 on Flex grant and contract management. The most recent VKGs including the January webinar on using rural data and the Critical Access Hospital Measurement & Performance Assessment System (CAHMPAS) can be found in the Flex Program Forum
  • Supporting FORHP in developing a PIMS data collection tool and also a Flex Program data table, so be released with the NCC in mid-March
  • Planning for speakers for the Flex Program Reverse Site Visit July 19-20 in Bethesda, MD. If you have speaker suggestions, please email Tracy Morton
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
Population Health Portal Update

In cooperation with the Federal Office of Rural Health Policy (FORHP), the  Population Health Portal has been updated with new resources to Get Motivated, Get Informed and Get Going to navigate the journey towards improved population health. 

The Data Tool focuses on specific scenarios for a hospital or county which allow users to analyze the data in the portal and also extract the data for further analysis in Microsoft Excel. The Data Tool includes three new scenarios and data updates to the six existing scenarios. Scenarios include explanations and instructional videos on how to use and export the data. A new resources provides examples of analyzing claims data.

The new Data Tool scenarios include:
  • Socioeconomic Status and Well-being
  • Understanding of Care and County Race Demographics
  • Uninsured Rates, Behavior and Mental Health
  • Using Claims Data
Assess your readiness and receive targeted tools and resources. Where are you in the journey towards population health? Complete the Critical Access Hospital Population Health Readiness Assessment, accessed on the portal, to connect with tools and resources targeted towards rural health organizations' unique strengths and needs for transitioning towards population health. 
Free Health Care Training

A joint opportunity provided by Johns Hopkins University School of Medicine and Normandale Community College to prepare you for the transition to value-driven care, enhance your role in health care and upskill your team and build teams to improve care delivery is being offered at no charge.

This training will help you and your organization understand health care transformation in a practical, usable way. These online courses will enhance skill sets to enable you or your staff to work more efficiently and effectively. By learning more about topics like data analytics, value-based care and population health concepts, your team will be more apt to thrive in the era of healthcare reform. This training will help all to use technology more effectively, improve care coordination, redesign workflows and more. 
MIPS Scoring: Quality, Advancing Care Information and Improvement Activities

In this webinar, Lisa Gall, Clinical Program Manager at Stratis Health, digs deeper into the Merit-Based Incentive Payment System (MIPS). Participants will learn why small and rural hospitals should consider voluntarily participating in MIPS to prepare for future value-based payments. Value-based care drives organizations to change the way care is provided from an individual patient and episode, to a broader, collaborative health care system. Learn how your hospital/clinic can deliver and engage patients and other health care providers to deliver population-based health care that focuses on patients across the spectrum of care in your community.  
Flex Virtual Knowledge Group Webinars

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 coordinated by RQITA will also continue to occur.

Please save the dates for the below VKG webinars. Calendar appointments will also be distributed:
  • Monday, March 6, 2017 - Flex Grant and Contract Management
  • Monday, April 3, 2017 - Working with CAHs to Implement Community Health Needs Assessments (CHNAs)
  • Monday, May 1, 2017 - Assessing State Emergency Medial Services (EMS) Capacity
  • Monday, June 5, 2017 - Mental and Behavioral Health
  • Monday, August 7, 2017 - How to Use Crucial Conversations

If you have any questions about the VKGs, please contact Bridget Hart.

Sea smoke on Lake Superior in Duluth, MN.
Photo by Nicole Clement, Senior Program Coordinator, The Center
New & Updated Resources

The following resources on the TASC website are new or recently updated.

Engaging Health Care Volunteers to Pursue the Triple Aim
 
NEW
Author: American Hospital Association (AHA)
This guide is intended to help hospitals and health systems develop volunteer services to strategically support the Triple Aim of improving the patient experience of care, improving the health of populations and reducing the cost of health care.

Author: Federal Office of Rural Health Policy
In the interest of making information on the Federal Office of Rural Health Policy's (FORHP's) rural areas more easily usable for researchers and other government agencies, FORHP has created a crosswalk of zip codes identifying the set of non-metro counties and rural census tracts that comprise rural areas as defined by FORHP.

Author: Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission
This guide provides an overview of dual-eligible beneficiaries who receive benefits from both Medicare and Medicaid. It uses data from calendar year 2012 to examine beneficiary demographics, utilization and spending patterns, eligibility pathways, annual program growth rates and more.

Author: The Joint Commission
This guide provides information to help health care organizations prepare for an onsite Joint Commission accreditation survey. It includes an ordered list of survey activities and details the logistical needs and objectives for each activity. The guide also makes suggestions about which staff members should participate in each survey activity. The guide contains clarifications and corrections for 2017 taht are specific to the critical access hospital (CAH) program.

New/Updated MBQIP Resources - are now in the 'MBQIP Highlights' section above.
Health-Related Behaviors by Urban-Rural County Classification

In this report, researchers find that rural Americans are less likely to practice healthy behaviors. Despite improvements in the overall health of Americans, people in rural areas are at greater risk for chronic disease. Practicing five health behaviors can help reduce that risk: 
  • Avoid smoking
  • Learn about and maintain a healthy body weight
  • Be physically active
  • Reduce or eliminate alcohol consumption
  • Get sufficient sleep

This is the first documentation of differences in health behaviors between urban and rural populations in the US. Rural residents are "recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than the overall population because the prevalence of disease and rate of premature death are higher than the overall population of the United States."

Connect Peer to Peer in Flex Program Forum
mailboxes
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 will need to login to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact TASC.  
New Rural Research

What is the Potential of Community Paramedicine to Fill Rural Healthcare Gaps?
This study collected information on rural community paramedicine in the US programs to describe their goals, target populations, services offered, connections with local community providers and resources, outcomes measured and results, where available.

Do Residencies that Aim to Produce Rural Family Physicinas Offer Relevant Training?
This journal article
examines the rural-centric family medicine residencies, their training locations, and rurally relevant skills training provided. Rural training can promote rural practice, but the number of family medicine residencies with a rural focus, geographic distribution of training, and training content are poorly understood.

Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
This journal article analyzes the reasons behind hospital-and county-level factors for rural obstetric unit closures.
Webinar Playbacks and Event Materials

Are you looking for resources in the topics of: subcontract management, MBQIP data reports, SHIP TA or rural financial strategies? Look no further!

TASC
SHIP 
National Rural Health Resource Center Blog
 
Stay in the loop by following the National Rural Health Resource Center blog

Recent posting:
Grow your Career: Save the Dates

Below is a list of upcoming events relevant to rural health:

Technical Assistance and Services Center (TASC)

Virtual Knowledge Group Webinar: Flex Grant and Contract Management
March 6, 2017 - 2:00 p.m. Central Time

EMS in the Flex Program: A Review of Current Activities and Insights from Flex Program Stakeholders
March 15, 2017 - 2:00 p.m. Central Time

Virtual Knowledge Group Webinar: Working with Critical Access Hospitals to Implement Community Health Needs Assessments
Monday, April 3, 2017 - 2:00 p.m. Central Time

Flex Program Workshop
April 11-13, 2017 Duluth, Minnesota

2017 Reverse Site Visit
July 19-20, 2017 Bethesda, Maryland

More 

April 25-26, 2017 Holiday Inn, Fargo, North Dakota

Wednesday, March 22, 2017 - 09:00 to Thursday, March 23, 2017 - 12:00

Rural Health Information Hub (RHIhub) Calendar
View upcoming rural events by month, s tate or keyword search.

The College of St. Scholastica is offering a Massive Open Online Course (MOOC) at no cost. The course begins March 1 and must be completed by May 22.
Are you interested in receiving quick, up-to-date information from the National Rural Health Resource Center? Like the National Rural Health Resource Center on Facebook and follow us on  Twitter and LinkedIn!

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