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Hello Everyone!
Spring is here and I, for one, am ready to enjoy a little of it. I'm excited to meet the new Flex Coordinators at the Flex Workshop in Duluth in a couple weeks as well as the Reverse Site Visit in July.
On March 23, we hosted the fiscal year (FY) 2017 Non-Competing Continuation (NCC) Grant guidance technical assistance webinar and would like to remind you that TASC is available to review one Flex grant component prior to your final submission; please see details below.
Below you will see an article dedicated to recognizing the success of our fourth CAH Recognition Certificate recipient. Please join me in congratulating Tillamook Regional Medical Center in Oregon 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)
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Welcome and Farewell
Welcome to:
- Abigail Garcia, State Office of Rural Health Manager, Indiana
- David Conrad, Flex Coordinator, Indiana
- Harold Clayton, Flex Coordinator, Arkansas
We bid a fond farewell to Chris Collins, SORH Director in North Carolina.
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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| Oregon Rural Health Director, Scott Ekblad, presenting the CAH Recognition Certificate to Tillamook Regional Medical Center. Pictured are Melody Ayers, Gina Seufert, Charles Saxon, Eric Swanson and Nick Watts |
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CAH Recognition - Emergency Medical Services Innovation
Congratulations to Tillamook Regional Medical Center (TRMC) in Tillamook, Oregon, as the fourth 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). Stacie Rothwell, Field Services Program Manager with the Oregon Office of Rural Health, nominated TRMC for their efforts and leadership.
In late 2014, the Oregon Health Authority (OHA) and the Oregon Office of Rural Health (ORH) solicited letters of intent from organizations interested in conducting telehealth pilot projects focused on care coordination, access to health data and expanding system capacity.
Since the project went live in October 2015, Tillamook Regional Medical Center has:
- Placed high-speed data connectivity in each ambulance to support direct, real time communication with Rural Health Clinic (RHC) Care Coordinators or providers to help individuals adequately manage their health care follow-up from the patient home or within the ambulance. Ambulances have been set up as mobile WiFi hotspots to ensure connectivity when patients' homes or service areas lacked coverage
- Purchased updated technology to support teleconferencing capabilities from patients homes via tablets as well as the capability to perform real time review and documentation in the patient chart through the electronic health record
- Implemented a process where hospital-based community paramedics received referrals to visit patients using telehealth technology. The patients were identified by the hospital case manager or the clinic care coordinator as being high risk for adverse health outcomes
- Developed workflows and policies with ongoing education and communication from leadership about the project and its overall goals. They were able to see significant staff and provider engagement.
TRMC has implemented an innovative Community Paramedic program in their county which will ultimately help hundreds of patients who would likely not have sought follow-up medical care until very ill. With continued support from the Oregon State Office of Rural Health, TRMC will build on the momentum and success it has had to improve workflows and processes.
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Sarah Young, FORHP |
Dear Flex Coordinators,
Of course, the update that's top of mind for everyone is the FY 2017 Non-Competing Continuation (NCC) that just came out on March 21, 2017. Please read the NCC instructions and go back and review the FY 2015 guidance if you need a refresher on the different core areas and activity categories in Flex. The Technical Assistance and Service Center (TASC) has the current FY 2017 instructions, FY 2015 guidance and updated work plan and new data table templates posted on the Flex Grant Guidance page.
The team at TASC and your project officers at the Federal Office of Rural Health Policy (FORHP) are all available to help you finalize your future work plan and performance narrative. Reach out when you have questions or want help considering different alternatives. Also, if you have questions about the NCC instructions, someone else does too--post your questions in the Flex Program Forum so others can learn from them as well.
A few words about the data table template: This format for presenting your outcome data feels unfamiliar because it is new. Keep in mind that this is simply a new format to better organize the outcome measures you've been working on for the last two years. It also clarifies that outcome measures should be tracked over time so that you have a three-year project history at the end of the project period.
In the context of the NCC and the new data table template, I'll revisit the question, "What do we mean by impact and outcomes?"
- Impact refers to the overall effects produced by a program or intervention.
- What are the positive and negative effects of the project? Another way to say this is to ask, "What changed because we did ______?"
- Outcomes are concepts and tools to measure impact. Outcome measures are specific, well-defined questions that use data to track specific changes.
- Outcome measures help us meet the challenge, "prove it".
At the program level, we link individual outcome measures to targets. Sometimes we undershoot our targets and sometimes we blow them out of the water, but either way, a target helps us know where to aim and lets us understand the amount of change we expect to influence.
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.
Until next time, happy Spring! Take a minute to enjoy the flowers as they bloom.
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Global Budget Process as an Alternative Payment Model
Rural health care delivery is being shaped by changes in payment policies and financing sources, continually evolving quality measures and expectations, evolving models of care to deliver services locally including from distant sources and regional health care affiliations. Success in this transformation requires high-performance rural health systems. The Rural Innovation Profile
Global Budget Process as an alternative payment model shares how McCready Health, a three acute care bed hospital, negotiates with the state commission to set the hospital's annual budget based on historic volume, costs and service pasterns, and regularly monitors and adjusts fees to achieve budget goals.
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CAH Regulatory Update
Chronic Care Management Payment Correction for Rural Health Clinics and Federally Qualified Health Centers
The Centers for Medicare and Medicaid Services (CMS) recently sent the following notice to rural health clinics (RHCs) and federally qualified health centers (FQHCs) regarding Chronic Care Management (CCM) billing: Effective January 1, 2016, RHCs and FQHCs received payment for CCM services based on the Medicare Physician Fee Schedule national average non-facility payment rate. However, for claims with dates of service on or after January 1, 2017, RHCs and FQHCs have been receiving a locality adjusted payment rate for these services. Your Medicare administrative contractor (MAC) will adjust any claim processed incorrectly. No provider action is required.
New Broadband Advisory Committee
Secretary Price highlights State Innovation Waivers
New Bundled Payment Programs Delayed
CMS has delayed the
effective date of the
Comprehensive Care for Joint Replacement (CJR) expansion and
episode payment models (EPMs) to improve cardiac care from March 21, 2017, to May 20, 2017. CMS also delayed the date when hospitals would be responsible for implementing these programs from July 1, 2017 to October 1, 2017. Most rural hospitals are unable to participate in the CJR or EPM models as the primary site of orthopedic surgery or heart attack care and bypass surgery, but are able to collaborate as post-acute care providers. CMS seeks public comments on the "appropriateness of this delay," as well as its consideration to delay these implementation dates even further, perhaps until January 1, 2018. Comments must be submitted by April 19, 2017.
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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
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 CMS inpatient and outpatient measures. CMS has delayed deadlines, and has been shutting down access to the database periodically in order to do maintenance. 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.
Abstraction Training Resources:
NEW
Online MBQIP Data Abstraction Training Series. This recorded training series of seven brief webinars is for CAH staff with responsibility for data collection of CMS Inpatient and Outpatient quality measures. listeners can pick individual topics, or listen to the full series for a comprehensive overview of the process to identify each measure population and abstract the required data elements.
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
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2017 dates:
- April 5, 2:00-3:00 p.m. CT
- June 28, 2:00-3:00 p.m. CT
- October 4, 2:00-3:00 p.m. CT
Note: registration is required, please follow
link for details.
Q4 2016 EDTC Reports - UPDATE
Due to an accidental data omission there is a slight change to the National ALL-EDTC rate from what was included in the Q42016 EDTC reports. The national average for ALL-EDTC is actually slightly higher at 75% rather than 74% (which is what is listed in the reports). All other sub-measure averages remain the same. The reports will not be re-distributed. Please let your Project Officer know if you have any questions.
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.
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.
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FY2017 Flex Grant Guidance Released
TASC would like to remind you that we are available to review one component of your Flex grant application prior to your final submission. If you would like assistance, please choose one section of your proposal for TASC to review and submit your request by May 2, 2017 and allow us four business days to review and provide feedback. TASC will respond with comments and suggestions, but is unable to re-write content.
- FY15-FY17 Grant Guidance documents
- FY17 Data Table Template
- FY17 Suggested Work Plan Template
- FY17 NCC Technical Assistance webinar recording
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| CAH Financial Indicator Medians by State
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TASC has been busy working on the following items for state Flex Programs, CAHs and other partners:
- Please see the above article about assistance available from TASC to support your NCC writing
- Virtual Knowledge Group (VKG) webinars - the next webinar will be April 3rd on Community Health Needs Assessments and How Flex Coordinators can utilize the findings for Flex activities. The most recent VKGs including the March webinar on contract management can be found in the Flex Program Forum
- Registration for the Flex Program Reverse Site Visit July 19-20 in Bethesda, MD will open VERY SOON!! stay tuned
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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Population Health Portal 
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.
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Differences in Health Care, Family and Community Factors Associated with Mental, Behavioral and Developmental Disorders Among Children Aged 2-8 Years in Rural and Urban Areas -- United States, 2011-2012
This report provides rural and urban data on a variety of health-related factors for children 2-8 years of age with and without mental, behavioral and developmental disorders. Topics addressed include demographics, health insurance coverage, having a medical home, parental mental health, family financial difficulties and community factors.
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Application Assistance for Telehealth Resource Center Programs
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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, 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.
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| Apple Blossoms, Courtesy of Burton Laine |
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New & Updated Resources
Author: Association for Community Health Improvement
The Community Health Assessment Toolkit is a web-based tool that offers a nine-step pathway to guide and support a robust, community-engaged health assessment process. Newly revised to better address the full cycle from assessment through implementation, this toolkit provides strategies fro each step of the process and a wealth of resources, including the guide to Community Preventive Services and other sources of evidence-based interventions.
Author: Stratis Health
This document consists of tables highlighting alignment between Uniform Data Set (UDS) measures and other quality reporting programs. It is intended to health health centers identify which UDS measures are being utilized by other programs such as the Centers for Medicare and Medicaid Services (CMS) accountable care organizations (ACOs) and the new CMS Quality Payment Program (QPP). Although federally qualified health centers and rural health clinics are exempt from QPP, they are encouraged to voluntarily submit quality data for the program.
Author: Rural Health Value
Using a market-based approach, this guide assists critical access hospital (CAH) leadership in identifying ways to demonstrate the value they bring to potential partners including networks, affiliations, payers, community based organizations or ACOs.
Author: Advisory Committee on Training in Primary Care Medicine and Dentistry
This document includes recommendations for the redesign of health professional training to meet the needs of an aging and diverse population, to become more team-based and interprofessional and to prepare students to serve in rural and underserved communities.
Author: National Rural Health Resource Center
This webinar recording provides clear insights of partnership perspectives of care coordination service as well as a demonstration of the value proposition tool.
New/Updated MBQIP Resources - are now in the 'MBQIP Highlights' section above.
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CMS Issues MOON FAQs for Hospitals as Requirement Takes Effect
Effective March 8, all hospitals and CAH must provide the standard notice to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours.
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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 will 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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New Rural Research
CMS State Innovation Models
The State Innovation Models (SIM) Initiative supports state governments with funding and technical assistance allowing them to design and test strategies that meet the goals of higher quality/lower cost health care delivery in a way that's tailored to the needs of their state's residents. Through two rounds of funding the SIM Initiative has created federal-state partnerships with 34 states, three territories and the District of Columbia. CMS has
considered input from many rural stakeholders in shaping the initiative and earlier this year, announced the
Pennsylvania Rural Health Model as one that potentially creates predictable funding to cover services for rural hospitals.
Rural Surgery: High Pressure but Rewarding
In
this column, Susan Long, MD, FACS describes the challenges, advantages and rewards associated with practicing surgery in a rural area.
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Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: NCC guidance, population health, PIMS, subcontract management, SHIP TA or rural financial strategies? Look no further!
Network
- Allied Health Networks
- Network Development
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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, April 3, 2017 - 2:00 p.m. Central Time
Wednesday, April 5, 2017 2:00 p.m. Central Time
April 11-13, 2017 Duluth, Minnesota
Monday, May 1, 2017 2:00 p.m. Central Time
2017 Reverse Site Visit
July 19-20, 2017 Bethesda, Maryland
April 25-26, 2017 Holiday Inn, Fargo, North Dakota
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.
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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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