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Hello Everyone!
Spring has not yet sprung here in Minnesota. We had more than six inches of snow over the weekend. As we hope for hammock weather soon, we've gathered some updates and resources for you.
We have been busy here at TASC with site visits, planning a great Reverse Site Visit (July 17-18) and the April Flex Workshop (April 10-12). To the Arkansas Flex Program, Sally and Nicole had a great visit; thanks for a great meeting.
Thank you to all of the Flex Programs who updated their State Flex Profiles. They are now available on the TASC website.
Please see below for more details. We've also updated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Overview Vendor Directory; you can find the directory on the TASC website and more information below.
Enjoy this month's edition of Rural Route and 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:
- Michelle Hoffman, Flex and SHIP Coordinator, South Dakota
- Hanna Robinson, Flex and SHIP Program Specialist, Utah
We encourage you to keep your Flex staff contact information current by completing the
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 |
Hi Flex Coordinators,
I'm sure the progress report for your fiscal year (FY) 2018 funding extension request is top of mind for everyone right now. If you missed the Flex Grant Extension Technical Assistance Webinar, please
watch the recording. I also expect you will have questions as you start working on your report-please post those questions in the
Flex Program Forum so we can all learn from them! I regularly monitor the Forum and so does the TASC team, and we will make sure you get timely answers. See the
Flex Grant Guidance page for additional materials, including instructions from prior years and the FY 2015 Notice of Funding Opportunity which is our governing document for this project period.
In the context of the progress report 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 is different because we implemented this project?"
Outcomes are concepts and tools to help us demonstrate impact.
Outcome measures are specific, well-defined questions that use data to track specific changes. Outcome measures help us meet the challenge, "prove it."
In contrast to outcome measures,
output measures help us understand the scale and scope of program activities. For example, the number of people participating in quality improvement workshops and the number of critical access hospital (CAH) site visits completed in a year are both output measures. Output measures are important for describing what the Flex Program is doing, but they cannot show the impact of the program by themselves. For the previous output examples, did the 100 workshop participants learn anything or change any behaviors? Did the 15 site visits lead to improved communication and more engagement with CAHs? Are those changes associated with better quality of care for rural people? These are outcomes and impact.
The
Flex Program Logic Model shows graphically how Flex activities, outputs and outcomes relate to one another. This model was presented at the 2017 Flex Program Reverse Site Visit, and I encourage you to look at it as you plan the next grant year.
I have also been working with Katy Lloyd, program coordinator for the Small Health Care Provider Quality Improvement Program. The Quality program is a Federal Office of Rural Health Policy (FORHP) Community-Based Division grant that provides support to mature networks of rural health care providers engaged in quality improvement initiatives to improve patient care and chronic disease outcomes. Approximately 70 grantees from the Quality program will be joining us July 17-18 in the same hotel as the Flex Program Reverse Site Visit. Both groups will have program-specific sessions, but will come together for several of the plenary speakers and for networking with our fellow rural health professionals. I'm really looking forward to learning from you and from the Quality grantees at this joint meeting. You can see a directory of Quality grantees and more information about their projects on the Rural Health Information Hub.
Until next time, happy spring! Our peak cherry blossom forecast in DC shifted two weeks later due to all of the cold weather we've had in March. (Thanks a lot, Punxsutawney Phil.) I will appreciate the cherries whenever they bloom though!
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CAH Regulatory Update
Proposed Changes to Short-Term, Limited Duration Health Insurance
A rule proposed jointly by the Internal Revenue Service (IRS), the Department of Labor (DOL) and the US Department of Health and Human Services (HHS) would amend the definition of short-term, limited-duration (STLD) health insurance. Currently, STLD plans can only provide coverage for three months or less, and they do not have to comply with Affordable Care Act (ACA) requirements for a qualified health plan (e.g. minimum essential health benefits, pre-existing condition exclusions). This rule proposes to allow STLD plans to provide coverage for up to 12 months and seeks public input on the proposed length of coverage, how to streamline re-application processes and the potential benefits and/or drawbacks of non-ACA compliant policies on risk pools and consumer costs. This is an opportunity for rural stakeholders to provide feedback on this proposed policy change including the impact on rural household premiums and out-of-pocket costs.
Comments are due by April 23, 2018. The Centers for Medicare and Medicaid Services (CMS) Fact Sheet provides more information on the intent of the proposed rule.
US Department of Veterans Affairs (VA) Revises Policy for Emergency Treatment Payment
The VA revised its
regulations concerning payment or reimbursement for emergency treatment for non-service connected conditions at non-VA facilities. As such, the VA will begin processing claims for reimbursement for reasonable costs that were only partially paid by the Veteran's other health insurance. Those costs may include hospital charges, professional fees and emergency transportation such as ambulances. For more details, refer to the
fact sheet for VA payment for emergency treatment. According to the VA's Office of Rural Health, a quarter of all US veterans - about 5.2 million - live in rural communities.
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Subject Matter Expert Calls Available to Flex & SHIP Programs
For a limited time, the National Rural Health Resource Center (The Center) and the Federal Office of Rural Health Policy (FORHP) are pleased to announce the availability of one-on-one technical assistance (TA) conference calls with subject matter experts (SMEs) for state Flex and SHIP Programs. This opportunity is only available to state Flex and SHIP Program staff. This TA is not open to hospitals/critical access hospitals (CAHs), other rural providers or partners. This is an opportunity for state Flex and SHIP Programs to receive TA in the form of a one-hour, individual phone conversation with a SME and to receive recommendations. States may receive one SME TA call for either Flex or SHIP on pre-determined topics for each program. For more information and the view the topics for both Flex and SHIP Programs, visit the TASC website
SME TA webpage. All SME calls must be completed by May 4, 2018.
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Flex Grant Extension Technical Assistance Webinar Recording
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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 soon. A draft agenda for the for the event is currently under development. Information regarding lodging and room rates will be forthcoming and 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 (FMT), Rural Quality Improvement Technical Assistance (RQITA), TASC Advisory Committee and staff of the Federal Office of Rural Health Policy (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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Abstracting for Accuracy Consultation
Stratis Health is offering a customized consultation that will provide CAHs with the opportunity to participate in an abstracting review process with Stratis Health Quality Reporting Specialist, Robyn Carlson, RHIA, CPHQ. The project aims to increase the validity of data collection and identify opportunities for additional training and clarification as it relates to chart abstraction for MBQIP core measures.
Space is limited! Please encourage CAHs in your state to participate.
DEADLINE MARCH 31! Visit the project page for more information.
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Flex Program Fundamentals Guide Updated
The
Flex Program Fundamentals Guide has been updated for 2018. The Flex Program Fundamentals Guide is a manual for those intimately involved with the Flex Program and is updated by TASC annually. We hope the Flex Program Fundamentals: An Introduction to the Medicare Rural Hospital Flexibility Program, is useful both as a resource for current Flex Program staff and as an orientation manual for new staff. The online version of the guide is available by section on the
TASC website. The guide includes the following sections:
- Introduction to the Flex Program
- Federal Office of Rural Health Policy
- Introduction to the Technical Assistance and Services Center
- Flex Monitoring Team
- Rural Quality Improvement Technical Assistance
- Flex Coordinator Reference
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Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Overview: Vendor Directory Updated
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Hospital Compare Results for CAHs 2016
The Flex Monitoring Team has released reports of critical access hospital (CAH) performance and reporting rates on selected Hospital Compare measures, utilizing data from 2016. Links to state-specific reports and a national summary report are available.
The Hospital Compare data in
this report include several measures that are also measures for the Medicare Beneficiary Quality Improvement Project (MBQIP).
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Medicare Accountable Care Organization Growth in Rural America
Accountable Care Organizations (ACOs) are the most-widespread of the Centers for Medicare & Medicaid Services (CMS) value-based payment programs and demonstrations. Several ACO demonstrations have been released by CMS's Innovation Center, many modifying previous demonstrations, or building on demonstrations to be more inclusive of small and rural providers. As a result, ACOs have expanded broadly into rural areas, albeit with lower beneficiary attribution numbers than in urban areas.
Using CMS data on Medicare beneficiaries attributed to Shared Savings ACOs in US counties for 2014-2016, the RUPRI Center for Rural Health Policy Analysis found and published in this data report, that nearly every county (or equivalent) in the US had at least one resident Medicare beneficiary attributed to an ACO in 2016. Over this period, there has been significant growth in ACO attribution in both metropolitan and non-metropolitan counties but the rate of growth in non-metropolitan counties has been substantially higher that in metropolitan counties.
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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:
April 30, 2018
Emergency Department Transfer Communication (EDTC)
- Patients seen Q1 2018 (January, February, March)
- Submission process directed by state Flex Program
May 1, 2018
CMS Population and Sampling (optional)*
- Patients seen Q4 2017 (October, November, December)
- Inpatient and outpatient
- Entered via the Secure Portal on QualityNet
May 1, 2018
CMS Outpatient Measures:
- Patients seen Q4 2017 (October, November, December)
- CMS Hospital Outpatient Reporting Specifications Manual version 10.0a
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 1.16
May 15, 2018
CMS Outpatient Web-based Measures:
- Includes measure OP-22: Patient Left Without Being Seen - full calendar year 2017
- CMS Hospital Outpatient Reporting Specifications Manual version 10.0a
- Entered via the Secure Portal on Quality Net
May 15, 2018
CMS Inpatient Measures:
- Patients seen Q4 2017 (October, November, December)
- CMS Hospital Inpatient Reporting Specifications Manual version 5.2b
- Submitted to the QualityNet warehouse via CART or by vendor
- CART version - 4.20.2
May 15, 2018
- Healthcare Personnel Influenza Vaccination - OP-27
- For data October 1, 2017 - March 31, 2018
- Submitted thru the National Healthcare Safety Network (NHSN)
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.
Please visit the MBQIP website for brief summary regarding the removal of these measures as well as an updated version of the
Resources
This Excel template can be used by Flex Programs to produce comparison graphs for CAHs that displays hospital and state performance on Centers for Medicare and Medicaid Inpatient and Outpatient measures. By using this template, Flex Programs can efficiently use data from the IP and OP data files received from the Federal Office of Rural Health Policy each quarter to produce graphs for inclusion in presentations or reports for CAHs in their state
This guide is intended to help critical access hospital (CAH) staff use Medicare Beneficiary Quality Improvement Project (MBQIP) Hospital Data Reports to support quality improvement efforts and improve patient care.
Upcoming Events
Stratis Health is offering a customized consultation that will provide CAHs with the opportunity to participate in an abstracting review process with Stratis Health Quality Reporting Specialist, Robyn Carlson, RHIA, CPHQ. The project aims to increase the validity of data collection and identify opportunities for additional training and clarification as it relates to chart abstraction for MBQIP core measures. Space is limited! Please encourage CAHs in your state to participate. Visit the
project page
for more information. Deadline to apply, March 31!
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:
- April 10, 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,
Supporting CAHs with Additional MBQIP Measures,
is scheduled for
April 19, 2018, from 2:00 p.m. - 3:30 p.m. Central Time.
More information will be sent to the appropriate email lists prior to the call. Recording of previous MBQIP VKG webinars are available in the Flex Program Forum. Contact
Jodi Winters
at Stratis Health with any questions.
Contact TASC with your inquiries, questions and comments related to MBQIP and/or resources.
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Spring time means event planning for the TASC Team. We are busy pulling the topical and logistical details together for the Flex Program Reverse Site Visit, July 17-18. Registration will be opening very soon so stay tuned for more information!
In mid-April we are hosting a group of new state Flex Program personnel and FORHP staff in Duluth for the FORHP Flex Program Workshop. We always look forward to this multi-day interactive training. If you'd like to come or anticipate new staff, the next training will be in October.
Lastly, please remember that TASC is available to help you with the Fiscal Year (FY) 2018 Flex Grant Extension. TASC is available to review one component of your Flex grant application prior to your final submission (examples: data table, work plan, narrative). If you would like assistance, please choose one section of your proposal for TASC to review. Please submit your request to tasc@ruralcenter.org by April 25, 2018 and allow us four business to review. TASC will respond with comments and suggestions, but we are unable to re-write content for you.
Please feel free to post your questions in the Flex Program Forum. If you have a question, someone else likely does too and will benefit from seeing the question and answer.
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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2018 State Flex Profiles Now Available on the TASC Website
Thank you to everyone who completed the annual update of the State Flex Profiles. State Flex Profiles showcase the beneficial activities occurring at the state-level to support the critical access hospitals (CAHs) and their communities around the country. No two states have the same exact approaches and the profiles are updated annually as an opportunity for states to share their excellent work and to learn from one another. The profiles include information on the work occurring in the five Flex Program areas as well as successes, best practices and innovations. Use the State Flex Profiles to identify approaches to similar rural health issues, identify best practice opportunities and access contact information for individuals at the state-level who are supporting Flex Program activities.
New Features in the 2018 Profiles
- Summary paragraphs on the main landing page
- Descriptions of state Flex Programs' enhanced use of data
- Sharing resource or tools a state Flex Program found useful and recommends to other Flex Program Colleagues
- New layout for program statistics
- Profile photographs for Flex Program staff that have uploaded a photo
What to do if you are missing or want to update content
States that did not submit updated profile content will only have contact information and links to RHIhub and Flex Monitoring Team information about their state displaying on their State Flex Profile. Should a state wish to update their profile, it can be done by completing the State Flex Profile questionnaire at https://www.ruralcenter.org/tasc/submit-state-flex-profile.
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| Thank you to the Arkansas Flex Program for a great site visit. Pictured: Christy Edwards, FORHP, Sally Buck, TASC, Andrea Ridgway, AR Office of Rural Health and Primary Care, Nicole Clement, TASC, Harold Clayton, AR Office of Rural Health and Primary Care |
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New Substance Use Resources
With the additional efforts and projects relating to substance use, TASC worked 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. TASC continues to identify and add new resources to the website.
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:
- John Henderson, Childress Regional Medical Center
- Evalyn Ormond, Union General Hospital
- Burke Kline, Greeley County Health Services
- Corie Kaiser, Oklahoma Office of Rural Health
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New & Updated Resources
The following resources on the TASC website are new or recently updated:
Author: Federal Office of Rural Health Policy (FORHP)
View and manipulate Flex Program summary data in an interactive map. Data to explore includes grant program financials, critical access hospital (CAH) quality data, CAH financial data, CAH location and Frontier and Remote Area (FAR) codes.
Author: Rural Health Value (RHV)
Learn about a Wisconsin rural health system that delivers behavioral health services as part of its comprehensive health and wellness approach in its rural health clinic (RHC). The facilities were able to identify options to allow the provision of behavioral health services by considering community need, financial reimbursement and provider motivation.
Author: Substance Abuse and Mental Health Services Administration (SAMHSA)
The Communities that Care curriculum equips communities with a public health prevention approach to target youth problem behaviors, such as violence, delinquency and substance misuse.
Author: Substance Abuse and Mental Health Services Administration (SAMHSA)
This set of toolkits aims to assist organizations and providers with the integration of behavioral health care into their settings. The toolkits include interactive resources, guides and assessments.
Author: American Health Information Management Association (AHIMA)
This toolkit was developed to advance knowledge and practices for engaging consumers in health care and to assist consumers in their role as advocates in their own healthcare. The toolkit covers the current landscape in supporting consumer engagement and includes suggestions for best practices, considerations for both healthcare professionals and consumers, and tools for leadership in consumer engagement challenges. The toolkit contains sections on operational and management considerations; legal considerations; challenges, issues and obstacles; education and training; the future of consumer engagement; and much more.
Author: Centers for Disease Control and Prevention (CDC)
This set of tools and resources is intended to assist practitioners with moving from data to action to address social determinants of health.
Author: County Health Rankings
Review key findings from the 2018 County health Rankings report. The County Health Rankings show that where we live matters to health. The 2018 report includes new analyses that show meaningful health gaps persist not only by place but also among racial and ethnic groups. These gaps are largely the result of differences in opportunities in the places where we live.
Author: County Health Rankings
Ranking the health of nearly every county in the nation, County Health Rankings & Roadmaps (CHR&R) Illustrates what they know when it comes to what is keeping people healthy or making them sick and shows what they know when it comes to what is keeping people healthy or making them sick and shows what can be done to create healthier places to live, learn, work and play. CHR&R brings actionable data, evidence, guidance and stories to communities to make it easier for people to be healthy in their neighborhoods, schools and workplaces. This resource includes state-specific reports discussing health equity status by state.
Author: County Health Rankings
This evidence-based tool will help communities find policies and programs that are a good fit for their priorities. Topics include health behaviors, clinical care, social and economic factors and physical environment.
New/Updated MBQIP Resources - are 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, Networks or Allied Health? Look no further!
TASC
Understand the history, theory and integration of process improvement in health care. Learn the difference between outputs and outcomes for Flex activities and discover where outputs and outcomes fit within Flex Program work and activities.
Understand the value of CAHMPAS and discuss different ways states are utilizing CAHMPAS. Learn best practices and tips for getting the most out of your CAHMPAS experience and hear about upcoming developments.
This webinar recording will help the viewer understand plans for Flex Program planning. Hear ideas for Flex Program future direction. Explore environmental scan data reflecting the current state of critical access hospitals and the national Flex Program.
Allied
Learn how the influx of younger workers from the Millennial and Global generation impacts the workforce. This webinar will discuss what motivates these two generations and explore the similarities and differences between them. We will also explore the change these generations force on the workplace as a whole.
Rural health network leaders discussed the role of networks in a changing health care environment during a September 2017 summit. Their findings, including six common roles networks should play to support network members in the transition to population health will be presented in this webinar.
SRHT
This webinar walks rural hospital leaders through the options to implement a financially sustainable care coordination program.
SHIP
This webinar discusses how Texas and G
eorgia are maximizing SHIP funds. It also gives an update from the Federal Office of Rural Health Policy.
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Grow your Career: Save the Dates
Below is a list of upcoming events relevant to rural health:
April 4, 2018 2:00 p.m. - 3:00 p.m. Central Time
Learn how to become a successful preceptor through facilitated conversation. The Health Care Collaborative of Rural Missouri will share how and why they developed their preceptor training curriculum, how to identify preceptor disconnects, the benefits of being a preceptor as well as provide a Google Classroom tour of their preceptor training modules.
April 19, 2018 2:00 p.m. - 3:30 p.m. Central Time
Learn how Flex Programs are supporting CAHs with quality improvement on additional MBQIP measures.
April 25, 2018 12:00 p.m. - 1:00 p.m. Central Time
The core mission of public health has consistently been to reduce the leading causes of preventable death and disability, with a special emphasis on reducing health disparities in underserved populations. Health departments, however, have varied in the extent to which they have adapted their practices to address the growing incidence of chronic disease, drug abuse, and suicide, now the leading causes of premature death in most rural communities in the United States.
May 8, - May 11, 2018
New Orleans, Louisiana
Groove to the pulse of more than 60 innovative, practical and cost saving sessions on what's working in rural health care.
May TASC 90
May 16, 2018 2:00 p.m. - 3:30 p.m. Central Time
June 25, 2018 - June 26, 2018
Duluth, Minnesota
Join us for one of the largest rural health conferences in the nation, with over 600 participants!
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