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Hello Everyone!
Fall has begun! I'm getting ready to carve pumpkins this week.
Let's have a pumpkin carving photo contest. Send along pictures of your pumpkins and we'll post a few of our favorites to the November edition of
Rural Route.
The October 2017 Flex Program Workshop was held last week. Thank you everyone who attended, both participants and speakers. We really appreciate our partners who contribute to the workshop, and couldn't do it without them.
There are some pretty important announcements in Sarah Young's update as well as other places in this edition of Rural Route so I'll keep my introduction short. 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:
- Johnnie Lovins, Rural Project Manager, Kentucky
- Toney Baily, State Office Director, Arkansas
Farewell to:
- Kathy Lubke, Program Support Supervisor, Montana
- Tina Turner, SORH Director, Ohio
- Jeremy Mason, Flex Coordinator, Mississippi
- Kenny Doppenberg, Flex Coordinator, South Dakota
- Nicole Linn, Flex Coordinator, Florida
- Ariel Serrano, Rural Project Specialist, Idaho
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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Sarah Young, FORHP |
Hello and happy October,
This month is the real start of fall in the mid-Atlantic region, and I'm looking forward to colored leaves, brisk sunny days and Goldrush apples. Last week I joined nine new and experienced Flex leaders at the Flex Program Workshop in Duluth. I say leaders deliberately because, regardless of your formal positions in your organizations, you are all leading some piece of the rural health improvement efforts in your state. Thank you everyone who attended the workshop for making time in your busy schedules to engage in learning and deep thinking about Flex. As always, the workshop reminds me of just how much you need to be aware of to be a Flex Coordinator!
My biggest take-away from this workshop was the importance of building relationships with your critical access hospitals (CAHs) and other local stakeholders. Crystal Barter (Michigan Flex) did a great job of explaining how she uses site visits to develop relationships with CAH staff and understand how to best structure the Flex work to meet Michigan needs. What activities and techniques do you use to build relationships with CAHs and other stakeholders in your state? If you've got an approach that works well, please share it in the
Flex Forum.
I've sent several program updates via the e-mail list in October so this is a brief recap. First, we are extending the current Flex project period with an additional non-competing continuation (NCC) year. You will write an NCC progress report next spring (instructions expected to be released in March 2018) and then you will write competing continuation applications in early 2019 for the fiscal year 2019 grant which will start 9/1/2019. Second, the Performance Improvement and Measurement System (PIMS) interface has software errors which we need to fix before finalizing PIMS reports. The developers have scheduled the software patch for November 2, and I will let you know via the e-mail list when the fix is confirmed. In the meantime, you can still log in to PIMS to review your CAH list or print a copy of the online reporting pages to review, but please don't enter any new data.
Also announced on the e-mail list, the 340B Program Hospital Recertification period is October 24-November 21. The Health Resources and Services Administration (HRSA) has information and tutorials available on the
Office of Pharmacy Affairs website. For further assistance, please contact the 340B call center operated by the 340B Prime Vendor Program at
apexusanswers@340bpvp.com or 1-888-340-2787 (Monday - Friday, 9 a.m. - 6 p.m. EST).
As mentioned in the September Federal Office of Rural Health Policy (FORHP) Announcements email, the Emergency Medical Services for Children (EMSC) Innovation and Improvement Center is inviting CAHs to participate in the
Pediatric Readiness Quality Collaborative. The deadline for applications is October 31.
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CAH Regulatory Update
Veterans Administration (VA) Publishes Telehealth Proposed Rule
The VA published a
proposed rule that would allow any VA health care provider to provide telehealth services across state lines. While such policy is currently in place, many VA medical centers have not expanded telehealth services due to conflicting state regulations for licensure, registration, certification or other requirements. If finalized, the proposed rule would preempt state law for telehealth providers working within the scope of their VA employment. The VA views this as an opportunity to expand health care to veterans, especially those living in remote, rural or medically underserved areas. Comments are due by November 1, 2017.
The Centers for Medicare and Medicaid Services (CMS) Revises Instructions for Medicare Cost Report Worksheet S-10
CMS released a Medicare Learning Network (MLN) Article on September 29, 2017, that summarizes revisions and clarifications to the instructions for Worksheet S-10 to ensure hospitals are appropriately reporting their uncompensated care costs.
CMS will begin incorperating uncompensated care data from Worksheet S-10 to distribute Medicare uncompensated care funds, beginning FY 2018 with Worksheet S-10 data from FY 2014 cost reports, as finalized in the FY 2018 IPPS/LTCH PPS final rule. CMS estimates this change will increase Medicare uncompensated care payments to rural hospitals by about 17% in FY 2018
Note: Critical access hospitals (CAHs) are not eligible for Medicare uncompensated care funds or Disproportionate Share Hospital (DSH) payments.
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Engaging State Offices of Rural Health and Rural Health Clinics in Value-Based Care
The National Organization of State Offices of Rural Health (NOSORH) is pleased to announce the release of their latest toolkit:
Engaging State Offices of Rural Health and Rural Health Clinics in Value-Based Care. NOSORH's Rural Health Clinic (RHC) Committee developed this latest module in a series designed to assist SORHs. This new toolkit aims to define what delivery system reform means, focuses on payment reform and includes care coordination and strategic collaboration initiatives for RHCs. This module also includes information on Medicaid initiatives, primary care models and future of delivery system reform plus SORH examples across the nation. All modules in this series can be found on the
NOSORH website.
NOSORH will host a webinar Tuesday, October 31st at 2:00 p.m. Central for on Engaging RHCs in Balue-Based Care to discuss the toolkit, the latest trends at the federal level for value-based care initiatives for RHCs and a SORH experience engaging RHCs. More information can be found on the
flyer.
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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
Upcoming Data Submission Deadlines:
October 31, 2017
Emergency Department Transfer Communication (EDTC):
- Patients seen Q3 2017 (July, August, September)
- Submission process directed by state Flex Program
November 1, 2017
CMS Population and Sampling (optional)*
- Patients seen Q2 2017 (April, May, June)
- Inpatient and Outpatient
- Entered via the Secure Portal on QualityNet
November 1, 2017
CMS Outpatient Measures:
- Patients seen Q2 2017 (April, May, June)
- CMS Hospital Inpatient Reporting Specifications Manual version 10.0a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 1.15
November 15, 2017
CMS Inpatient Measures:
- Patients seen Q2 2017 (April, May, June)
- CMS Hospital Inpatient Reporting Specifications Manual version 5.2a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 4.19.1
*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.
FIXED!
Outpatient Population and Sampling: We have just been informed that entry of Outpatient Population and Sampling data directly into the grid in the QualityNet Secure Portal is again functional. Hospitals are encouraged to enter their population and sampling data for Q2 2017 before the November 1st deadline. Instructions for entering Outpatient Population and Sampling data can be found on page 5 of the MBQIP Reporting Guide. Please contact Robyn Carlson with questions, or if any of your hospitals indicate that direct entry of this data into the grid is not working.
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
This Excel template can be used by Flex Programs to easily produce comparison graphs for CAHs that displays hospital and state performance on CMS Inpatient (IP) and Outpatient (OP) measures for inclusion in presentations or reports for CAHs in their state.
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
.
2018 dates:
- January 10, 2:00 - 3:00 p.m. CT
- April 11, 2:00 - 3:00 p.m. CT
- June 20, 2:00 - 3:00 p.m. CT
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
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
December 21, 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
with your inquiries, questions and comments related to MBQIP and/or resources.
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EMSC Innovation and Improvement Center Inviting Critical Access Hospitals to Participate in Upcoming Pediatric Readiness Quality Collaborative
The Emergency Medical Services for Children (EMSC) Innovation and Improvement Center is inviting CAHs to participate in the upcoming Pediatric Readiness Quality Collaborative (PRQC). The PRQC will work with 20 state or territory teams to collectively improve their pediatric readiness scores by 10 points. This collabroative will focus on four areas of improvement:
- Assessing and documenting weight in kilograms
- Detection and notification of abnormal vital signs
- Interfacility transfer processes
- Disaster preparedness
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This month, TASC has been working to develop technical assistance (TA) support for the Flex Supplemental Funding participants. We look forward to supporting those states and hospitals to demonstrate excellent improvement outcomes. There is a TASC 90 webinar on November 8 on Flex Program work with rural accountable care organizations (ACOs). We are finalizing the content on a cybersecurity guide for small rural hospitals and clinics, to be released later this fall. We're putting together thoughts on the next opportunity to nominate your state's excellent critical access hospitals (CAHs) for a CAH Recognition Certificate. We have also set up the schedule for the upcoming monthly Virtual Knowledge Group (VKG) calls - the first call will be November 6 on using the Core Competencies for State Flex Program Excellence. Last week we hosted the Flex Workshop in Duluth. It is always great getting to know new Flex staff and reconnect with those we've not seen for a while.
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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340B Program Hospital Recertification Period, October 24 - November 21, 2017
Prior to being able to recertify, you must set up a user account in the new 340B Office of Pharmacy Affairs Information System (340B OPAIS). If you have not already done so, please go to the
340B OPAIS website and set up your user account. After you set up your account, you will be able to recertify your covered entity and contract pharmacies during the recertification period, make changes to your records and terminate sites at any time. Failure to set up user accounts will result in not being able to view accounts or conduct recertification, thus removal from the 340B program.
As a reminder, authorizing officials (AOs) and primary contacts (PCs) must create individual user accounts. They will not be able to share access.
For assistance with the
340B OPAIS, please utilize the online help that is available. The Health Resources and Services Administration (HRSA) also has information and tutorials available on
HRSA's website. For further assistance please contact the 340B e-mail the 340B
Prime Vendor Program or call at 1-888-340-2787 (Monday - Friday, 8:00 a.m. - 5:00 p.m. Central Time).
Post any 340B questions to the
Flex Forum and Sarah Young will work OPA to get answers. Remember, the
OPAIS page has a number of how-to-webinars (under educational resources) and public users can search the system to see which hospitals and CAHs are registered at 340B Covered Entities.
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| Portland Head Lighthouse, Caleb Siem |
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SRHT Project Releases New Templates for Rural Hospitals
The 2017 Rural Hospital Value-Based Strategic Summit was held to provide leaders with templates that improve organizational planning, strengthen actionable steps and operationalize key strategies that enable hospitals and networks to effectively transition to value.
Balanced Scorecard and Strategy Map Templates (c
ustomizable MS Word documents)
The Transition to Value Strategy Map and Balanced Scorecard Templates are provided as separate downloadable Microsoft Word documents. The templates are ready to use and are designed to allow hospital and network leaders to incorporate and expand their organizations' strategic plans to provide a framework that supports population health preparedness.
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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:
- Leslie Hall, Michigan Rural EMS Network (MiREMS)
- Roger Wells, Howard County Medical Center
- Amanda Basso, CSuite Consulting
- Tim Putnam, Margaret Mary Health
- Mark Lindsay, Mayo Clinic College of Medicine
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Rural Innovation Profile
The
Rural Health Value team recently released a new
Rural Innovation Profile focused on how a nonprofit health care network integrated a medical-legal partnership, as one of the clinical and community support services, into its chronic care management for low-income chronically-ill patients to reduce the non-medical factors that affect their health outcomes.
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Sliding Fee Scale Discount Guide for Critical Access Hospitals
and Rural Health Clinics Updated
This guide provides critical access hospital (CAH) and rural health clinic (RHC) executives and management teams with concepts and guidance in developing a sliding fee scale discount program. It also assists in providing an understanding of how sliding fee discount programs relate to Internal Revenue Code Section 501(r) compliance and participation in the National Health Service Corps.
The updated Guide includes the following:
- Reasons to implement a sliding fee scale discount program
- Developing a sliding fee schedule discount program
- Setting policies
- Creating a sliding fee scale discount structure
- Using a sliding fee scale discount program at your organization
- Updated Consideration for 501(r) compliance
- Updated National Health Service Corps participation
- Updated Appendix: Example Sliding fee schedule
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New & Updated Resources
The following resources on the TASC website are new or recently updated:
Author: National Organization of State Offices of Rural Health (NOSORH)
View a fact sheet that explains what the Medicare performance-based adjustment programs are, types of programs, how they impact rural hospitals and where to find more information.
Author: NOSORH
A fact sheet that defines the Quality Payment Program (QPP), discusses how it impacts a rural practice and where to find more information.
Author: Minnesota Department of Health (MDH)
This toolkit shares the stories and experiences of three pioneering collaborations between local public health and health care agencies in Minnesota that are using electronic health record (EHR) and public health data to improve the health in their communities. The toolkit includes lessons learned and tools to encourage the application of data to knowledge and how to move the knowledge into practice to improve community health.
Author: Centers for Medicare and Medicaid Services (CMS)
This methodology fact sheet describes the process and methodology that CMSwill use to identify eligible clinicians who, through their participation in Advanced Alternative Payment Models (APMs), are Qualifying APM Participants (QPs) for a year and will be eligible to receive the 5% APM Incentive Payment.
Author: Intitute for Safe Medication Practices (ISMP)
This tool offers hospitals, long-term care facilities and outpatient facilities a unique opportunity to assess the safety of systems and practices associated with up to 11 categories of high-alert medications. ISMP defines high-alert medications as those drugs that bear a heightened risk of causing significant patient harm when used in error.
Author: NOSORH
This document aims to define what delivery system reform means, focuses on payment reform and includes care coordination and strategic collaboration initiatives for RHCs. This module also includes information on Medicaid initiatives, primary care models and the future of delivery system reform plus SORH examples across the nation.
Author: CMS, Substance Abuse and Mental Health Services Administration (SAMHSA)
This document is designed to serve as a behavioral health resource for consumers and offers important information about mental health and substance use disorder services, including definitions of behavioral health terms and guidance on how to find a behavioral health services provider, receive treatment and obtain follow-up care. It provides simple explanations of feelings and behaviors that may need attention, a checklist for getting help and treatment and tips for managing long-term behavioral health care.
Author: CMS
Minority populations experience disparities in the health care quality they receive, even when they have the same insurance, socioeconomic status and comorbidities as their non-minority counterparts. Browse through the resources and tools on evidence-based interventions that can contribute to reducing health disparities and lowering cost.
Author: Stratis Health
This online tool is available to help clinicians prepare for and succeed in the CMS QPP. Clinicians can use this tool, at no cost, to determine which measures and data submission method should give them the highest Merit-based Incentive Payment System (MIPS) final score. The higher their score, the better-positioned clinicians are to receive the highest possible positive Medicare payment adjustment in 2019 under MIPS, and ultimately to continue to improve the quality and value of care delivered.
Author: Stratis Health
This recorded training series is for CAH staff with responsibility for data collection of CMS Inpatient and Outpatient quality measures. Pick individual topics that you have questions about or listen to the full series for a comprehensive overview of the process to identify each measure population and abstract the required data elements.
Author: Rural Health Information Hub (RHIhub)
CMS has established Medicare billing codes for services intended to keep beneficiaries healthy and better coordinate services to support beneficiaries at home. Each of the guides provides a brief overview and links to key documents to help rural healthcare professionals, practices, and hospitals understand the billing code, consider the benefit to their patients and organization, and begin billing for the code. These guides include annual wellness visits, chronic care management and transitional care management.
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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Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: TASC, SHIP, SRHT or Networks? Look no further!
TASC
Networking opportunity for Flex Programs to discuss CAH improvement strategies for immunization measures and use of groups in the National Healthcare Safety Network (NHSN) for supporting MBQIP.
Network
This presentation walks through a strategic planning toolkit to support rural health networks in developing an effective and dynamic strategic plan.
Other
Since 2005, 122 rural hospitals have closed - 80 since 2010. George Pink, PhD, from the North Carolina Rural Health Research and Policy Analysis Center presented updated and new data about closed rural hospitals and their post-closure disposition. A model predicting financial distress and closure in rural hospitals was also described. Characteristics of hospitals at high risk of financial distress were identified and trends in risk of financial distress among rural hospitals analyzed.
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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.
November, 6, 2017 2:00 - 3:00 p.m. Central Time
Utilizing the Core Competencies for State Flex Program Excellence
November, 16, 2017 1:00 - 2:00 p.m. Central Time
Hosted by the HRSA Federal Office of Rural Health Policy (FORHP) and the Centers for Disease Control and Prevention (CDC)
November, 8, 2017 2:00 - 3:30 p.m. Central Time
Flex Program Work with Rural Accountable Care Organizations (ACOs)
Virtual Knowledge Group Webinar
December, 4, 2017 2:00 - 3:00 Central Time
Topic to be determined
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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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