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Hello Everyone!
It is officially winter and the days have started getting longer so get out there and enjoy.
Thank you to the Utah Office of Primary Care and Rural Health for hosting Tracy Morton and me for a Flex Site Visit earlier this month it was great to get to know the team and to experience Salt Lake City.
Please enjoy this month's edition of Rural Route. Thanks for reading.
As always please send any pictures you happen to take along your travels. We enjoy highlighting the beauty found in the places we serve.
Until next time,
Caleb Siem, MH
Program Specialist
Technical Assistance and Services Center (TASC)
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Welcome and Farewell
Welcome to:
- Merica Tripp, Flex support staff, Maine
We encourage you to keep your Flex staff contact information current by completing the new
Flex Contact Information Form
as soon as possible whenever there are changes in your office. Please review your contacts as listed in your
State Flex Profile and complete the form as necessary for any additions or changes.
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Sarah Young, FORHP |
Happy November,
Happy (belated) National Rural Health Day! I hope you proudly celebrated the Power of Rural on November 16. Here in Rockville, we hosted
a series of events for our Health and Human Services colleagues in the building and engaged on social media and webcasts. Check out the
HRSA infographic!
#OurRural
You made it through November and you've submitted your Performance Improvement and Measurement System (PIMS) report. Congratulations! Please reach out to your project officer (PO) if you have any lingering questions since the report is due November 30. We will review your PIMS submissions and let you know if we have any questions. Once all of the reports have been approved by your POs, I will be analyzing the data and then share my findings with you in a PIMS webinar in January.
Do you have any questions or comments about PIMS while you are fresh from completing your annual report? Please let me know! I would like to keep making PIMS clearer and easier to use and the only way I can practice continuous improvement is with your help and feedback.
Thank you for your hard work on behalf of critical access hospitals (CAHs) and rural communities.
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2018 Flex Program Reverse Site Visit
We are pleased to announce that the 2018 Flex Program Reverse Site Visit (RSV) will be held July 17-18, 2018 at the Omni Shoreham Hotel in Washington, DC. This in-person Flex grantee meeting is supported by the Federal Office of Rural Health Policy (FORHP).
The purpose of the Flex Program RSV is to highlight the latest information and issues in the Medicare Rural Hospital Flexibility (Flex) Program, as well as offer states an opportunity to share experiences, lessons learned and successes in a collaborative learning environment.
Online registration for the Flex Program RSV will open in March 2018. A draft agenda for the for the event is currently in development. Information regarding hotel booking and room rates will be forthcoming. Further information will be provided as it is made available. Please don't hesitate to contact us if you have any questions.
The intended audience for the Flex Program RSV is State Office Directors, Flex Coordinators/other key Flex personnel (two per state), the Flex Monitoring Team, Rural Quality Improvement Technical Assistance (RQITA), the TASC Advisory Committee and staff of FORHP. If you would like to have more than two attendees, please contact your project officer at FORHP for approval.
Concurrent to the Flex Program RSV, the National Rural Health Association (NRHA) and FORHP Community-Based Division will be hosting events at the Omni Shoreham Hotel. This will be a prime opportunity to network with your fellow state constituents.
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CAH Regulatory Update
The Centers for Medicare and Medicaid Services (CMS) Finalizes Changes to Hospital-based Bundled Payment Programs
CMS finalized its proposed changes to the Episode Payment Models (EPMs) and Comprehensive Care for Joint Replacement (CJR) models on December 1, 2017, effective January 1, 2018. Please see the
CMS fact sheet.
Proposed Rule for Medicare Advantage and the Prescription Drug Benefit Program
CMS has proposed several changes to
Medicare Advantage and Part D Plan rules for 2019 that are relevant to rural enrollees, providers and stakeholders, such as allowing plans to send more materials to enrollees electronically, increasing flexibilities in plan design and adding tools for Part D plans to manage and monitor access to opioids.
Comments are due by January 16, 2018. See the CMS
fact sheet for more information
New Participants for Rural Community Hospital Demonstration
CMS announced that 13 new hospitals will join the Rural Community Hospital (RCH) demonstration. First implemented in 2004 as a five-year demonstration, RCH demonstration has been twice extended, most recently by section 15003 of the 21st Century Cures Act. As authorized by the Cures Act, RCH will run for another five years through 2021.
Ombudsman for New Medicare Cards
CMS announced a new ombudsman, Dr. Eugene Freund, who will serve as a resource for health care providers with concerns or questions about the new Medicare beneficiary enrollment cards. CMS will begin mailing the new cards to people with Medicare benefits, including rural beneficiaries, in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. The new Medicare cards will contain a unique, randomly-assigned number that replaces the current Social Security-based number. To reach the new ombudsman, email NMCProviderQuestions@cms.hhs.gov.
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National Rural Health Information Technology (HIT) Coalition Face-To-Face Meeting
The National Rural Health Information Technology (HIT) Coalition is holding an in-person meeting during the
National Rural Health Association Rural Health Policy Institute. The National Rural HIT Coalition meeting will be held
Tuesday, February 6, 2018 from 4:30 p.m. - 6:00 p.m. Eastern Time at the
Omni Shoreham Hotel in Washington, DC. Topics will include national and legislative updates in HIT, telehealth and others to be determined.
If you would like to attend the February 6th meeting of the Coalition or participate by phone, please email Nicole Clement at the National Rural Health Resource Center at nclement@ruralcenter.org.
The Rural HIT Coalition is a network of rural and health information technology leaders from regional, state, national and federal organizations, working together to advance the implementation of HIT across rural America. The Coalition addresses key issues facing Rural HIT adoption including: ensuring HIT workforce; establishing business processes; connecting rural health care communities; promoting quality initiatives; pursuing needed IT infrastructure; ensuring rural citizen access; and assisting with the unique needs of minority and special needs populations.
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MBQIP Highlights & Resources
As a reminder, please send your MBQIP questions to the Technical Assistance and Services Center (TASC)
email address. TASC will ensure your question reaches the best person to answer.
MBQIP Data Reporting Reminders
Upcoming Data Submission Deadlines:
January 31, 2018
Emergency Department Transfer Communication (EDTC):
- Patients seen Q4 2017 (October, November, December)
- Submission process directed by state Flex Program
February 1, 2018
CMS Population and Sampling (optional)*
- Patients seen Q3 2017 (July, August, September)
- Inpatient and Outpatient
- Entered via the Secure Portal on QualityNet
February 1, 2018
CMS Outpatient Measures:
- Patients seen Q3 2017 (July, August, September)
- CMS Hospital Inpatient Reporting Specifications Manual version 10.0a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 1.16
February 15, 2018
CMS Inpatient Measures:
- Patients seen Q3 2017 (July, August, September)
- CMS Hospital Inpatient Reporting Specifications Manual version 5.2b
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 4.20
*Population and Sampling refers to the recording of the number of cases the hospital is submitting to the QualityNet warehouse this is done directly through the QualityNet Secure Portal.
Note:
The entry of Outpatient Population and Sampling data directly into the grid in the QualityNet Secure Portal is again functional.
CMS has announced that four of the Outpatient Measures that are currently required for MBQIP will be removed following Q1 2018 data submissions!
- OP-1: Median Time to Fibrinolysis
- OP-4: Aspirin at Arrival
- OP-20: Door to Diagnosis Evaluation by a Qualified Medical Professional
- OP-21: Median Time to Pain Management for Long Bone Fracture
Submission of these measures will be included in the evaluation of CAH participation in MBQIP for FY 2018, but will be removed from MBQIP evaluation criteria and MBQIP reports starting with Q2 2018 discharges (encounters as of April 1, 2018).
CAHs should continue to collect these measures through Q1 2018 encounters (due 8/1/2018). Starting with Q2 2018 encounters, the measures do not need to be collected, and the QualityNet warehouse will no longer be accepting submission of data for these measures.
Resources
Author: Stratis Health
For use by Flex Programs in helping CAHs with quality data reporting by reminding them of upcoming data submission deadlines, corresponding collection time periods and submission tools.
Author: Stratis Health
The MBQIP Measures Fact Sheets provide an overview of the data collection and reporting processes for the Medicare Beneficiary Quality Improvement Project (MBQIP) measures. The goal of this resource is to capture details regarding the MBQIP measures and provide them in a basic, one-measure-per-page overview. The intended audience for these fact sheets is critical access hospital personnel involved with quality improvement and/or reporting and state Flex Program personnel.
Author: Stratis Health
This guide is intended to help Flex Coordinators, critical access hospital (CAH) staff and others involved with the Medicare Beneficiary Quality Improvement Project (MBQIP) understand the measure reporting process. For each reporting channel, information is included on how to register for the site, which measures are reported to the site and how to submit those measures to the site.
Upcoming Webinars
Tuesday, January 23, 2018, 1:00 - 2:00 Central Time
FORHP and CDC are offering this webinar to provide additional information about completion of the NHSN Annual Facility Survey and use in monitoring implementation of antibiotic stewardship programs.
Ask Robyn - Quarterly Open Office Hour Calls for Data Abstractors
Scheduled approximately one month before data submission deadlines each quarter, Rural Quality Improvement Technical Assistance(RQITA) Quality Data Specialist Robyn Carlson will be offering open office hour calls to respond to MBQIP data abstraction questions
.
2018 dates:
- January 10, 2:00 - 3:00 p.m. Central Time
- April 11, 2:00 - 3:00 p.m. Central Time
- June 20, 2:00 - 3:00 p.m. Central Time
Note: registration is required, please follow this
link for details.
MBQIP Monthly
MBQIP Monthly is a monthly e-newsletter that provides CAHs with information and support for quality reporting and improvement and highlights current information about MBQIP. State Flex Programs are encouraged to distribute MBQIP Monthly to their CAHs as an additional resource to supplement state level MBQIP support. The most current version always available on the
MBQIP Monthly webpage
.
MBQIP Virtual Knowledge Groups (VKGs)
(RQITA) and the Technical Assistance and Services Center (TASC) have teamed up to host MBQIP VKG webinars to give you the opportunity to share MBQIP successes, challenges, barriers and brainstorm strategies to assist hospitals towards reporting, participating, improving and excelling in the four MBQIP quality domains.
These calls/webinars are intended for state Flex Program personnel and designated contractors. The next MBQIP VKG call is scheduled for
February 15, 2018, from 2:00 p.m. - 3:30 p.m. Central Time with the topic to be determined.
More information will be sent to the appropriate email lists prior to the call. Contact
Jodi Winters
at Stratis Health with any questions or for access to the recordings of previous VKG webinars.
Contact
TASC
with your inquiries, questions and comments related to MBQIP and/or resources.
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This month, the Technical Assistance and Services Center (TASC) has provided a webinar recorded on December 7 on how to use the Recommendation Adoption Progress (RAP) Interview, a required part of the Flex Supplemental Funding project. Other items TASC has been working on include:
- Finalizing the content for a cybersecurity guide for small rural hospitals and clinics, to be released later this winter
- Virtual Knowledge Group (VKG) webinar on January 8 about capturing CAH finance and leveraging data for CAH financial improvement
- Developing the agenda, speakers and theme for the 2018 Flex Program RSV in July
- Updating the Fundamentals of Flex Guide, to be released in January
- Planning a face-to-face meeting for the National Rural HIT Coalition on February 6 in Washington, DC
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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State Flex Profile Updates
It's that time of year again! TASC is requesting an updated State Flex Profile from all Flex states by
January 5, 2018
.
In addition to many events, resources and tools, the TASC website is also host to your state's Flex Profile. Flex Profiles are structured around the five Flex Program areas and include opportunities to share successes and information about what's going on in your state. Your updated State Flex Profile is due by
January 5, 2018.
What's Included in a State Flex Profile:
- Your Flex Program's efforts and successes in each of the five program areas
- Your Flex Program's success stories related to reporting or using quality data to help CAHs improve patient care
- Your Flex Program's demonstrated efforts in assisting CAHs and their communities transition to value-based care
- Networks and collaboratives that your Flex Program is involved in and/or facilitates
- Your Flex Program's enhanced use of data in the past year
- An opportunity to share tools and/or resources
State Flex Profiles allow TASC and other states to quickly scan and identify best practices that your Flex Program is involved in. This does not need to be a reiteration of your grant application! Rather, we invite you to use this opportunity to demonstrate how you are addressing the Core Competencies for State Flex Program Excellence and apply those activities to the five program areas. State Flex Profiles are meant to be a tool to connect state Flex Programs that share similar activities or can benefit from a mentor-mentee relationship to address an area of the program.
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Characteristics of Communities Served by Hospitals at High Risk of Financial Distress
Since 2005, there have been 124 rural hospital closures in the US. Rural hospital closures can intensify already challenging health and economic issues for rural communities. People served by rural hospitals tend to be older, poorer, have access to fewer health care professionals and have overall worse health outcomes than those served by urban hospitals. To better understand the causes of hospital closure,
this brief compares the characteristics of communities served by rural hospitals at high risk of financial distress to those served by rural hospitals that are not at high risk of financial distress.
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| Best wishes for a healthy and happy holiday season from all of us at The Center! |
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Revealing the Scope of Rural Obstetrics (OB) Unit Closures
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New Substance Use Resources
With the additional efforts and projects relating to substance use, TASCworked with John Gale from the Flex Monitoring Team to identify resources that might be useful to
you and your hospitals as you work to meet the challenges of substance use/abuse.
Resources available in the TASC resource library focus on prevention, tools for providers, examples of other programs and other topics as well. Please take a look at a sample of the resources below. Please share with those who can benefit from these resources and suggest any others to TASC you have found helpful.
Many more resources can be found on the
TASC website by searching for "substance use" or other key words in the search field.
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Weekly Rural Health Leadership Radio Program
A weekly radio program,
Rural Health Leadership Radio
, was launched a year ago to support rural health leaders to share stories and information about what is working, and what is not. To read the story of the program's development please visit an
article
promoting the resource from the National Organization of State Offices of Rural Health. Here are a few recent speakers:
- Sarah Hughes, United Healthcare
- Roger Knak, Fairview Regional Medical Center
- Nicole Weathers, University of Iowa College of Nursing
- Allan Jenkins, University of Nebraska at Kearney
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Thank you to the Utah Office of Primary Care and Rural Health
for a great Flex Program Site Visit |
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State Flex Program Rural Emergency Medical Services (EMS) Assessment Strategies
The guidance for the Fiscal Year 2015 Flex Program funding cycle required any state interested in undertaking EMS projects to conduct an EMS assessment during the first year and use the results to inform its activities in subsequent years. The
latest policy brief from the Flex Monitoring Team provides an overview of the EMS assessment projects and tools implemented by five State Flex Programs: Arizona, California, Minnesota, Nebraska and Wisconsin.
Based on grant applications and progress reports submitted by State Flex Programs, their assessment tools and reports, and interviews with key informants, this brief provides insight into the scope, development and implementation of state EMS assessments. It highlights lessons learned to inform the efforts of anyone interested in conducting their own rural EMS assessments.
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New & Updated Resources
The following resources on the TASC website are new or recently updated:
Author: American Hospital Association (AHA)
The AHA has created four resources specific to post-acute care providers to help find measures that align work the organization is already doing with the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Author: Technical Resources, Assistance Center, and Information Exchange (TRACIE)
This page provides links to resources that can help providers and suppliers comply with the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness rule.
Author: Center for Health Care Strategies (CHCS)
See examples of tools used to better capture patients' social needs and barriers of care.
Author: CHCS
This brief examines how organizations participating in Transforming Complex Care, a multi-site national initiative funded by the Robert Wood Johnson Foundation, are assessing and addressing social determinants of health (SDOH) for populations with complex needs. It reviews key considerations for organizations seeking to use SDOH data to improve patient care, including: (1) selecting and implementing SDOH assessment tools; (2) collecting patient-level information related to SDOH; (3) creating workflows to track and address patient needs; and (4) identifying community resources and tracking referrals.
Author: Health Research and Educational Trust (HRET)
This resource is intended for hospitals participating in the Hospital Improvement Innovation Network (HIIN) project led by the Centers for Medicare and Medicaid Services (CMS) and Partnership for Patients (PFP). It is meant to be a tool to help make patient care safer and improve care transitions. This change package is a summary of themes from the successful practices of high performing health organizations across the country. It was developed through clinical practice sharing, organization site visits and subject matter expert contributions. This change package includes a menu of strategies, change concepts and specific actionable items that any hospital can implement based on need or for purposes of improving patient quality of life and care. This change package is intended to be complementary to literature reviews and other evidence-based tools and resources.
Author: Technical Resources, Assistance Center, and Information Exchange (TRACIE)
This collection of cybersecurity resources from the Technical Resources, Assistance Center, and Information Exchange (TRACIE) of the US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) includes a collection of resources related to cybersecurity including incident management, legal/regulatory resources, lessons learned and plans, tools and templates and much more
Author: Office of the National Coordinator for Health Information Technology (ONC)
With the nationwide focus on value and quality in health care as well as incentives for health care providers to transform their practices and care delivery, most acknowledge that investing in health information technology (health IT) is an imperative. For many, the question of how to get health IT to work efficiently and effectively in practice remains a challenge. There are a number of strategies, recommendations and best practices based upon implementation experience from a variety of clinical settings available in the Health IT Playbook
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 log in to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact
TASC.
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Flex Monitoring Team Resources
The Flex Monitoring Team has recently released two great resources we would like to bring to your attention.
Telehealth Webinar Recording
On this webinar representatives from Hawaii and Nevada discuss their state Flex Program's efforts to launch and sustain a Project ECHO initiative within their respective states, including best practices and lessons learned.
HCAHPS Results for CAHs, 2016
The Flex Monitoring Team has released reports of Critical Access Hospital (CAH) performance and public reporting rates on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, utilizing data from calendar year 2016. Links to state-specific reports and a national summary report are now available.
- Are your CAHs looking to change HCAHPS vendors? Please see the semi-annually updated HCAHPS Vendor Directory to support CAHs and other rural hospitals in choosing a HCAHPS vendor that can meet their needs.
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Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: TASC, SHIP, SRHT or Networks? Look no further!
TASC
- TASC 90: Flex Program Work with Rural Accountable Care Organizations (ACOs)
Learn the performance observations and evidence of rural accountable care organization (ACO) involvement. Discover opportunities for state Flex Program involvement in supporting value-based models of care and understand the successes and challenges of rural ACOs and how the state Flex Program can play a supportive role.
Network
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Project Evaluation Plan Toolkit
Evaluation planning can guide a rural health network in collecting information on project activities, tracking progress towards objectives and identifying project improvement opportunities. In this webinar, the presenters will walk through an evaluation planning toolkit to support networks in developing evaluation plans.
Other
This webinar brought together an innovative payer (Anthem Blue Cross Blue Shield) and providers to explain the rapid shift in EMS' role in tomorrow's healthcare landscape and will answer the most important questions facing EMS agencies.
The team from North Sunflower Medical Center talks about their role in forming the Mississippi Diabetes Telehealth Network and the steps they've taken in moving their community toward population health
Review national data on burnout and share how health care systems across the state of Minnesota are working together to combat this crisis.
Transition strategies identified from the 2017 Rural Hospital Value-based Strategic Summit are presented with strategy map and balanced scorecard templates to help leaders execute and manage strategic plans. Tutorial and update on the SRHT Toolkit are included.
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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:
View upcoming rural events
by month, s
tate or keyword search.
January 8, 2017 2:00 p.m. - 3:00 p.m. Central Time
Capturing CAH Finance: Leveraging Data for CAH Financial Improvement
January 4, 201 12:00 p.m. - 1:00 p.m. Central Time
In this webinar, Dr. MacKinney will discuss the patient safety landscape, how patient harm and death occurs, the High-Reliability Organization and the rural hospital journey to zero harm.
January 10, 2018 12:00 p.m. - 1:00 p.m. Central Time
This webinar will explore the issues driving substance use in rural communities and discuss the role of rural hospitals in supporting and participating in community-based strategies and programs to address this ongoing population health problem.
January 18, 2018 1:00 p.m. - 2:00 p.m. Central Time
This presentation by John Gale, MS, of the University of Southern Maine focuses on a wide range of strategies that communities can use to combat the opioid problem.
January 24, 2018 12:00 p.m. - 1:00 p.m. Central Time
Learn how to assess your current performance and choose reporting strategies that make the most sense to your practice and your patients. See how to test various reporting methods and plan improvement goals.
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LinkedIn!
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