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Hello Everyone!
It was great to meet and see everyone at the Flex Workshop in Duluth earlier this month. We had some great weather, which has encouraged me to get outside and enjoy spring. We have a lot of updates and info in this month's
Rural Route so I'll keep my intro short. I would like to draw your attention to a few things.
The National Rural Health Resource Center will have a booth and several staff members attending the Annual National Rural Health Association's Rural Health Conference, May 9-12, in San Diego; please stop in to say hello.
The Rural Health Data Summit date and location has been set. Please see information concerning lodging and registration below.
You will also find a list of publications from a range of topics all focused on rural health from the last year or so.
A reminder that TASC is available to review one section of your NCC application. Please send your request by May 2, and allow four days for review.
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:
- Kendra Baldridge, Interim State Office of Rural Health Director, Kansas
We bid a fond farewell to Sara Roberts, State Office Director in Kansas.
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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April 2017 Flex Workshop Attendees:
Trent Engledow (Texas),
Harold Clayton (Arkansas), Gloria Davis (Alabama), Shannon Chambers (South Carolina), Kimberly Brent-Jones (Louisiana), David Conrad (Indiana), Rebecca Dobert (Oregon), Kevin Fleming (Kentucky), Kayla Combs (Kentucky), Caleb Siem (TASC), Robyn Carlson (Stratis Health), John Olson, (Vermont), Nicole Clement (TASC), Daniel Prokop (Ohio), Lori Parsons (Iowa),
Bridget Hart (TASC), Tyler Jensen (Nevada)
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Review of Peer-Reviewed Journal Articles Recently Published from the Rural Health Research Centers
Some journal articles are freely available but many will require a
subscription
or affiliation with a subscribing library. Please visit the Rural Health Research Gateway to learn more.
Financial
Emerging Care Trends
Maternal/Child Health
Medicare
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Sarah Young, FORHP |
Dear Flex Coordinators,
Happy Anniversary! That's right, this is my twelfth Rural Route update which means I have been your Flex Program Coordinator for a full year now. Looking back at my first update in May 2016, I was talking about the Performance Improvement Measurment System (PIMS) data then and, as you saw if you follow the Flex Forum, we just rolled out a new PIMS data download feature for you to use last Friday
.
You are all working hard on your non-competing continuation (NCC) write-ups. There have been some good questions posted in the Flex Forum. Please keep them coming! Your questions help you write a better progress report and they help us improve the Flex Program. I know that we can never anticipate all problems in advance so I'm committed to practicing continuous quality improvement within the Flex Program itself.
Also on the NCC, remember this is your chance to talk about your successes. Don't hesitate to brag! You are doing great work and you should highlight it.
A few topics I hope you will include in your NCC narrative, as applicable to your program:
- Are you doing anything in your Flex program with telehealth or Project ECHO models?
- How does your state Flex work relate to behavioral health, substance abuse treatment and/or opioid use disorders?
- How many CAH site visits have you completed and planned?
Until next time, keep up the great work and keep asking questions!
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CAH Regulatory Update
Centers for Medicare and Medicaid Services (CMS) Delays Update to Rules for Home Health Agencies (HHAs)
CMS finalized new rules for HHAs participating in Medicare and Medicaid on January 13, 2017, to incorporate recent advances and current medical practices that focus on patient-centered, data-driven and outcome-oriented care. On April 3, 2017, CMS delayed the effective date of these new rules from July 13, 2017 to January 13, 2018. Comments related to this delay can be submitted by June, 2, 2017.
2018 Medicare Advantage and Part D Plan Payment and Policy Updates
CMS has finalized
2018 payment updates for Medicare Advantage and Part D plans, including policies that encourage safeguards when prescribing opioids.
Specifically applicable to rural populations, CMS reinforces in this letter that Medicare Advantage Organizations (MAOs) are expected to promote access to high-quality and culturally competent health care services to vulnerable populations including racial and ethnic minorities, people with disabilities, sexual and gender minorities and rural populations. Furthermore, this letter clarifies that regulations that prohibit discrimination do not preclude a MAO from conducting outreach that targets a portion of the population or provides targeted interventions to a specific subset of enrollees.
CMS Selects Accountable Health Communities (AHC)
The AHC Model is moving forward with
identification of 32 local-level organizations that will bridge the gap between clinical and social need providers to address housing instability, food insecurity,utility needs, interpersonal violence and transportation. One example of how this can work is rural areas is offered by the Oregon Health and Science University, which plans to collaborate with more than 50 clinical sites across nine counties to coordinate services for residents.
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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
The next submission deadline for Outpatient population and sampling data is May 1, 2017 (Q4 2016 data). Due to a technical issue in the QualityNet database, CAHs are currently not able to submit Outpatient Population and Sampling data using the grid in the QualityNet Secure Portal. The work-around available from CMS is for CAHs to create and upload an XML file, which is a more time consuming and technical process. It is unclear when the database issue will be fixed but it is anticipated that the use of the work-around XML submission process will be needed for at least the next couple of quarters.
Resources
Author: CMS
Overview of the steps required for entering abstractions into CART. This presentation also demonstrates how to export your abstractions and submit your data into the QualityNet Secure File Transfer. Included are tips and tricks to help you along the way.
Author: Stratis Health
This guide highlights ideas for Flex Programs to foster an informal peer mentoring environment, followed by basic guidance to develop a more intentional and structured peer mentoring program for their critical access hospitals. Sample documents from the formal peer mentoring program in North Dakota are included.
Author: National Rural Health Resource Center and Stratis Health
This crosswalk provides a basic understanding of quality reporting initiatives taking place on a national level including the lead organization and purpose of such initiatives, the measures used by each initiative and any overlap in measures across initiatives.
Author: Institute for Healthcare Improvement
This resource page from the Institute for Healthcare Improvement describes using pull systems to improve flow and provides links to a variety of change ideas that focus on improving patient flow in hospitals.
Author: Stratis Health
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
.
2017 dates:
- 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 May 1, 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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Rural Health Data Summit
This event is designed for two audiences: Primarily, the data analysts and managers who understand and use rural health data regularly. Secondarily, program managers and directors who make strategic decisions on the use of data, and who are willing to go deep in these topics. The agenda is intended to be participatory and will include:
- Technique Demos
- Show and Tell
- Top 5 Resources for Inspiration and Information
- Ask the Group
- Rural Health Data Trends
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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
- Planning speakers for the Flex Program Reverse Site Visit. Registration to Open SOON - Look for the e-mail!
- Work continues on the PIMS Data Collection & Reporting Tool
- Planning upcoming Virtual Knowledge Group Call for May 1 which will focus on EMS
- Planning upcoming May 24 TASC 90 webinar to provide an update on the use of the 2016 Rural Hospital Leadership Summit on Strategies for Rural Hospitals Transitioning to Value-based Purchasing and Population Health. Webinar will include an update on rural research, notes from the field in working with CAHs and state Flex Program activities to support the strategies
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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Rural Opioid Abuse Prevention and Treatment Strategies: The Experience in Four States
The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, North Carolina, Vermont and Washington State,
this qualitative study explores promising state and community strategies to tackle the opioid crisis in rural communities and identifies rural challenges to the provision of Opioid Use Disorder (OUD) prevention, treatment and recovery services.
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Issues Confronting Rural Pharmacies after a Decade of Medicare Part D
The financial viability of small rural pharmacies became a concern following the advent of Medicare Part D in 2005. Previously receiving payment directly from Medicare based on charges, pharmacies now are reimbursed by private insurance plans per the terms of contracts offered by those plans.
This brief assess the issues that threaten the sustainability of small rural pharmacies after more than 10 years of experience with Medicare Part D.
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Access to Obstetric Services in Rural Communities
Access to obstetric care in rural communities is critical to ensuring good maternal and child health outcomes. Although over 28 million reproductive-aged women live in rural US counties, 43% of rural counties in the U.S. had no hospital-based obstetric services in 2002. Media coverage and reports since then have indicated that the number or rural hospitals providing obstetric care has been decreasing; however, the national scope of these access problems has not been quantified.
A recent project by the University of Minnesota Rural Health Research Center has resulted in two policy briefs which examine the closure of hospital-based obstetric services in rural areas from 2004 to 2014.
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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, May 1, 2017 - Assessing State Emergency Medial Services (EMS) Capacity
- Monday, June 5, 2017 - Flex Program Performance
- 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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| Photo Courtesy of Sarah Young who "tramped across the sheep fields to see the standing stones near the sea", Scotland. |
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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: National Rural Health Resource Center and Stratis Health
This crosswalk is intended to provide users with a basic understanding of quality reporting initiatives taking place on a national level involving critical access hospitals (CAHs) including: the lead organization and purpose of such initiatives, the measures used by each initiative and any overlap in measures across initiatives.
Author: Stratis Health
This document provides an overview of the overall Hospital Quality Star Ratings initially released July 2016 by the Centers for Medicare & Medicaid Services (CMS). The document includes background information, a summary of methodology and discussion/talking points.
Author: North Carolina Rural Health Research and Policy Analysis Center
The Flex Monitoring Team makes financial indicator data available to every critical access hospital in the United States on an annual basis. These data include financial statement and operating indicator analyses to create numbers for hospitals that have easily-interpretable financial significance and allow CAHs to compare their financial performance to peer facilities.
Author: Rural Health Value
Rural Health care deliver 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 patterns, and regularly monitors and adjusts fees to achieve budget goals.
New/Updated MBQIP Resources - are now in the 'MBQIP Highlights' section above.
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Centers for Disease Control and Prevention (CDC) Rural Health Webinar Series
Mental, behavioral and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors and less access to health resources. The webinar will begin with researches examining the factors impacting mental and behavioral health for rural children. This will be followed up with a discussion about the experience of one community's response to this growing issue. Time will be available for a Q&A with the presenters. Connection details will be emailed to you immediately upon registration a recording will be available after the event.
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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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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, May 1, 2017 2:00 p.m. Central Time
Wednesday, May 24, 2017 2:00 p.m. Central Time
Monday, June 5, 2017 2:00 p.m. Central Time
Thursday, June 8, 2017 2:00 p.m. Central Time
July 19-20, 2017 Bethesda, Maryland
View upcoming rural events
by month, s
tate or keyword search.
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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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