Conditions of Participation Information Request

CMS published a notice on August 30, of the intent from CMS to continue collecting information as part of the CAH conditions of participation. Information collected is used by surveyors to ensure CAHs are eligible to participate in the Medicare Program. Comments regarding the proposed information collection must be submitted by September 29.

The Federal Office of Rural Health Policy (FORHP) will host a webinar on Wednesday, August 30, 2:00 p.m. - 3:00 p.m. Central Time. FORHP will review highlights of the FY2017 Flex NOAs and updated reporting instructions for the next PIMS report. PIMS will open for reporting September 1, reports are due October 30.

The webinar will include PIMS screenshots and discussion of how to transfer data from the PIMS Data Collection tool into the PIMS online interface, as well as an explanation about how your project officer will be reviewing your PIMS report once its submitted.

Topic: Fiscal Year 2017 Flex NOA and PIMS

Date: Wednesday, August 30, 2017

Time: 2:00 p.m. Central Time

Duration: 1 hour

Audience: State Flex Coordinators

Speaker: Sarah Young

Connection information:  https://hrsa.connectsolutions.com/fy2017flexnoa/

Dial-in: 888-946-3801, passcode 8500332

The webinar will be recorded with playback available on the TASC website.

Coteau des Prairies Keeping Services Close to Home 

Coteau des Prairies Health System (CDP) is a 25-bed, not-for-profit CAH, providing acute care, swing bed, primary care, emergency medicine, surgery, rehabilitation therapies, imaging, lab, nutrition and pharmacy services to the residents of Sisseton, South Dakota and surrounding communities. Their mission is to provide "Quality Care with a Personal Touch, Close to Home." In 2016, CDP was supported by the Small Rural Hospital Transition (SRHT) Project with a Financial Operational Assessment (FOA). The FOA assesses the hospital's operations at the department level to establish planning priorities and develop action steps to implement best practices that improve efficiency. The objective is to financially position the hospital for the future.

CDP Reports Continued Accomplishments

Coteau des Prairies Health System indicates exemplary quality reporting and performance improvement in MBQIP as indicated by the largest change in rankings in reporting, performance, and overall rankings across all domains from data submitted between Q2 2014 - Q1 2015 (EDTC Q1 - Q4 2015) to this year's rankings from data submitted between Q1 2015 - Q4 2015 (EDTC Q1 - Q4 2016).

• Revenue cycle management changes included a new co-pay policy and implementation of front-end collection. Gross revenues are beginning to grow
• Team leaders are now included in oversight of their financials and departmental budgets and receive in-depth training
• CDP is now publicly reporting HCAHPS scores and they are beginning to see improvement
• Medical executive committee was created to collaboratively address provider issues
• Emergency department was recently remodeled and CDP is working with providers and the community to better educate them about the options for care
• CDP created a new swing bed marketing strategy resulting in an average daily census of 4.6, surpassing their goal of 4
• Outpatient market share is increasing with the addition of a full-time general surgeon, ear/nose/throat specialist and ophthalmology. They are considering the addition of oncology and sports medicine 

As a result of this project, leadership notes that staff is more aware of ways they impact the financial success of the hospital, increased trust of the new leadership team and there is improved communication and problem solving.

 

(We are) "realizing changes (in health care) are not just a trend so it's sticking around. CDP is now being more proactive instead of reactive. We are doing better with benchmarks." Michael Coyle, CSP Chief Executive Officer

 

Coteau de Prairies Keeping Service Close to Home: full article

At the 2017 Flex Program Reverse Site Visit last month, Sarah Young from FORHP introduced a Flex Program Logic Model. Please take time to review the model and send any thoughts or comments to Sarah at syoung2@hrsa.gov

TASC Tasks 

TASC is wrapping up final content for this program year. Items coming out soon include:

• August 30 joint webinar with the SRHT Project on findings and new templates from the Rural Hospital Value-based Strategic Summit
• Release of the semi-annual update of the HCAHPS Vendor Directory
• Release of an update to the Sliding Fee Scale Discount Guide for Critical Access Hospitals that includes information on the National Health Service Corp and rural health clinics (RHCs)
• Release of a cybersecurity tool and checklist for small rural hospitals, CAHs and RHCs at the end of August

CMS: Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P) 

On August 17, CMS released the proposed rule that would cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model. The proposed rule would also make changes to the Comprehensive Care for Joint Replacement (CJR) model and give certain hospitals, including low-volume and rural hospitals, a one-time option to discontinue participation. Additional information is available on the  August 15, 2017, CMS fact sheet . Comments regarding the proposed rule must be submitted no later than 5:00 p.m. Eastern Time on October 16, 2017. 

Source: Federal Register

Webinar & Tool: CAH Pro Forma for Shared Savings 

Health care is on a path to value, regardless of health care reform uncertainties. Thus, CAHs need to understand accountable care, especially if considering joining an Accountable Care Organization (ACO). This webinar will present a new Excel-based tool developed by the Rural Health Value team and Premier, Inc. The Critical Access Hospital Pro Forma for Shared Savings assesses the financial implications of joining a Medicare Shared Savings Plan ACO. The publicly available, free tool highlights five-year revenue and expense forecasts financial projections that compare current state to Medicare ACO participation and an easy to understand table and chart summary outputs, including hospital and physician financial projections.

Webinar speakers:

• Clint MacKinney, MD, MS, Clinical Associate Professor in the Department of Health Management and Policy at the College of Public Health, University of Iowa and Deputy Director of the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy and Analysis
• Jane Jerzak, CPA, RN, Partner, Wipfli LLP

Listen to the Webinar

Access the Pro Forma Tool

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. To name just a few, previous and upcoming speakers include names you may be familiar with include:

• Don Kelso, Indiana Rural Health Association (IRHA)
• Lara Brroks, Oklahoma Office of Rural Health and Dr. Brian Witacre, Oklahoma State University 
• Brian Bauer, Hall, Render, Killian, Health and Lyman, PLLC
• Michelle Mills, Colorado Rural Health Center
• Tim Size, Rural Wisconsin Health Cooperative

New Program Aims to Keep OB/GYNs in Rural America 

Women in rural areas of the U.S. often have to travel 30, 60, 90 minutes or more in order to reach a facility with maternity services. A new residency program at the University of Wisconsin School of Medicine and Public Health seeks to address this issue by training obstetrician/gynecologists in rural areas - with the hope they will eventually work there.

New Rural Health Research 

The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals

The purpose of this brief is to describe Medicare post-acute and hospice care provided by rural hospitals (or in rural areas) by characterizing 1) the variation in the number of rural hospitals that provide post-acute care and hospice care, 2) the average amount of Medicare revenue rural hospitals receive for these services, and 3) the financial importance of PAC and hospice care services to rural hospitals. The description of PAC and hospice care provided in this brief is meant to help highlight the potential impact a change in reimbursement might have on rural hospitals and their communities. 

Regional Differences in Rural and Urban Mortality Trends

Previous research has established both that there is a gap in nationwide urban-rural mortality and that this gap is increasing over time. Existing and ongoing work has found that the urban-rural mortality gap may vary regionally. This brief builds upon previous research and explores the differences in mortality trends between urban and rural locations by census division from 1999 to 2015. The disparity after 2007 is larger than the disparity before 2007 in all nine census divisions. The urban-rural disparity also varies regionally; for example, rural mortality rates and differences between the urban and rural mortality rates, are the highest in the Southeastern United States. The regional variation in the rural and urban mortality gap over time suggests that more research must be done to explain underlying causes of these disparities and to support the development of policies that can mitigate them. 

Use of the Emergency Department for Mental Health and Substance Abuse among Women

This study identifies trends among women in rural and urban communities who utilize the emergency department for mental health and substance abuse. The information can be used to help communities provide more relevant, appropriate and less costly care.

After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care

A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.  

The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits among Medicare Beneficiaries

This journal article uses national representative 2007 to 2010 Medicare data to examine the relationship between rural health clinic (RHC) use and potentially preventable hospitalizations and emergency department visits. RHC use was associated with an increase in both preventable hospitalizations and emergency department visits among all Medicare enrollees, regardless of their reason for eligibility.

Rural Tobacco Control and Prevention Toolkit 

This new toolkit, developed by the NORC Walsh Center for Rural Health Analysis, provides information, strategies and resources to help rural communities implement tobacco control and prevention programs. The toolkit offers program models and examples, and information on how to implement, evaluate and sustain a program in your community and disseminate program results.

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 . 

If you have questions about the Flex Program Forum, please contact TASC.  

 

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