Rural Route
 
July, 2019
In this Issue
MBQIP Updates
TASC Updates
Webinars & Events
Resources
FMT Resources
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State Flex Profiles

FMT

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CMS

Hello Everyone!

I hope you all had as good of an experience at the 2019 Flex Reverse Site Visit (RSV) earlier this month as I did! Thank you to those who were able to make the trip to D.C. and partake in the meeting.

Also, a special thank you to all of our speakers and all of those who helped in the planning process. We really appreciate all of your hard work. If you would like to review any of the presentations from the event, please go to the RSV website.

I hope you enjoy this month's edition of Rural Route. We appreciate you taking the time to read it.

Thank s,                              
Andy Naslund
Program Coordinator
Technical Assistance and Services Center (TASC)
             

Welcome to Laura Fischer of Illinois, Kathryn Metzger of Missouri, and Abbie Parmenter of Florida.  We are happy to have you as part of Flex!

We bid a fond farewell Teresa Leatherman of Missouri and Elizabeth Cobb of Kentucky. We with them both well!

Please keep your Flex staff contact information current by completing the  State Flex Program Contact Information Form  whenever there are staffing changes in your office. 

FORHP Updates                                 

Hi Flex Folks, 

It was great to see everyone (and talk to most of you) at the Flex Reverse Site Visit (RSV) the second week of July. Thank you for traveling from all over the country to join us for two days of Flex-focused content. I hope you got a lot out of the meeting. 

Do you have a great take-away or a burning question from the RSV? Post it in the Flex Forum and let's have a discussion.

Of course the Flex award cycle never stops, as you saw in the busy timeline in our Flex Program update. The Notices of Award (NOAs) for Fiscal Year (FY) 2019 will come out in August and the Performance Improvement and Measurement System (PIMS) will open for FY 2018 reporting on September 1, 2019. I've scheduled a webinar for August 22, 2019, to review the end-of-year reporting and the new NOAs. See the save-the-date message sent through the Flex mailing list for more details.

Do you have questions about the year-end reports or other topics? Please send them to TASC and to me by August 20,2019, and we will address them on the webinar.

Happy back-to-school month to those with children and happy vacation to those who are taking some time away from the office for summer fun. I'll talk to you in August.

Sarah Young

Flex Program Coordinator


CAH Regulatory Update

Updates include: 
  • The Center for Medicare and Medicaid Services (CMS) proposed rule change to the Home Health Prospective Payment System (Home Health PPS)
  • Comment request for Federal Communications Commission's (FCC) Connected Care Pilot Program
  • CMS proposed payment models for transforming kidney care
  • CMS proposed rule on Methods for Assuring Access to Covered Medicaid Services-Rescission.
Continue reading CAH Regulatory Updates (Flex Forum login required - contact  TASC for details)

Please send your MBQIP questions to the tasc@ruralcenter.org. TASC will ensure your question reaches the appropriate person.
HRSA MBQIP Performance Standards: Public Comment

Dear Flex Program personnel and subcontractors,
 
Since the Medicare Beneficiary Quality Improvement Project (MBQIP) was started in 2011, we have seen reporting rates increase in all four MBQIP domains. While reporting rates remain an important indicator of engagement, the Federal Office of Rural Health Policy (FORHP) is seeking opportunities to focus more on measure quality performance and improvement.

Over the past year, the FORHP and the Rural Quality Improvement Technical Assistance team (RQITA) developed a means to evaluate and set goals for MBQIP quality performance and improvement at measure, domain, programmatic, state, and national levels. We gathered input from state Flex Programs through Virtual Knowledge Group and focus group calls and refined the methodology. The result is the proposed
MBQIP Performance Standards
 
The purpose of the MBQIP Performance Standards is, first and foremost, to set national goals for MBQIP and evaluate performance and improvement from a national level down to a specific measure.
 
We are reaching out to you now to get your input! As state Flex Coordinators and MBQIP subcontractors, we want to ensure that you have the opportunity to provide us feedback on the methodology and how you envision FORHP and/or states could utilize these MBQIP Performance Standards.
 
The public comment period will be from Tuesday, June 25 - Monday, August 12, 2019. Please submit your public comments in our fillable form here:  http://www.cvent.com/d/vyqlqx
 
Thank you,
 
Yvonne Chow (Yiu)
MBQIP Coordinator

HRSA Recognizes 10 States for Top Performance at Critical Access Hospitals

The Health Resources and Services Administration (HRSA) presented 10 states with the 2019 Medicare Beneficiary Quality Improvement Project (MBQIP) Quality Performance Awards. These awards recognize achieving the highest reporting rates and levels of improvement in critical access hospitals (CAHs) over the past year.


This year's 10 top performing states are: Pennsylvania, Massachusetts, Michigan, Utah, Alabama, Nebraska, Illinois, Maine, Minnesota, and Wisconsin. These states built on their previous successes by investing funding from HRSA's Federal Office of Rural Health Policy (FORHP) into quality improvement projects and developing technical assistance resources that improve high-quality care in their communities. States also work collaboratively with every CAH and their respective partners to share best practices and utilize data to drive quality improvement in their hospitals.

HRSA created the MBQIP to promote high quality care at rural hospitals with 25 or fewer beds. Hospitals that participate in MBQIP voluntarily report quality measures relevant to the care they provide, share data, and take on quality improvement initiatives. Of those engaging in improvement initiatives, 72% have improved outcomes on the reported measures.

"MBQIP is part of a broader portfolio of activities within HRSA to preserve hospitals and help rural communities to continue their access to quality health care. Ensuring rural hospital viability is an important component of HRSA's strategic efforts on high quality and value-based care," said Dr. George Sigounas, HRSA Administrator.

"We're happy to work with the states on this effort," said Tom Morris, FORHP Associate Administrator. "They've done a great job showing that CAHs can be national leaders in quality improvement and that results in better care in rural communities."
Rural Health Care Leader Presented Calico Leadership Award

John Barnas, Executive Director of the Michigan Center for Rural Health (MCRH), a non-profit affiliate of Michigan State University, was awarded the Calico Leadership Award at the 2019 Flex Program Reverse Site Visit held July 10-11 in Washington, DC. "John is an exceptional mentor and leader. He has built an environment at MCRH which is supportive, motivating, purpose-driven, accountable, and fun!" commented Crystal Barter, Director of Performance Improvement, MCRH.

From left to right: Kristi Martinsen, Division Director, FORHP; John Barnas; Terry Hill, E xecutive Director of Rural Health Innovations and Senior Advisor for Rural Health Leadership and Policy, The Center
The Calico Leadership Award is presented annually by TASC to an outstanding rural health leader. The Calico Award was created in honor of long-time rural health leader, Dr. Forest Calico, for his life-long commitment to improving the quality of rural health. This year's award was presented to John for his outstanding leadership. Over his 25-year career at the Michigan Center for Rural Health, Barnas has been a catalyst in advancing Michigan's rural health care facilities, including a current focus on supporting rural participation in the Medicare Share Savings Accountable Care Organization Program and other alternative payment models in Michigan's rural facilities.
John has given countless hours to advancing rural health by actively participating on various boards, councils, and committees. Currently John serves on the National Rural Health Association Government Affairs Committee and Rural Health Congress, a board member of the National Organization of State Offices of Rural Health and the Small/Rural Hospital Council of the Michigan Health and Hospital Association. Barnas is a past-chair of the TASC Advisory Committee.
Terry Hill, Executive Director of Rural Health Innovations and Senior Advisor for Rural Health Leadership and Policy of The Center noted, "John Barnas has been an important national rural health leader in America for the past 20 years. His innovation, hard work, and passionate dedication to improving the health of rural citizens in this country have made him a worthy recipient of this award."
CAHMPAS Database Update

The Flex Monitoring Team recently completed some major enhancements to CAHMPAS! The Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) is a data tool that lets you explore critical access hospital (CAH) performance on financial, quality, and community benefit measures.

Quality Improvement Data

Quality data are now aggregated to the state-level and are publicly available through the recently updated CAHMPAS tools. Users can create customized tables and graphs with Hospital Compare data, including inpatient, outpatient, and patient engagement (HCAHPS) measures. Users can make comparisons between states, and also create tables and graphs for individual or pre-defined sets of measures.

A video tutorial and PDF step-by-step guide were created to help get you started with the new Quality portal in CAHMPAS.

Community Characteristics Data 

Data on community benefit expenditures and CAH service mix as well as the characteristics and vulnerabilities of counties in which they are located are now publicly available through CAHMPAS and searchable at both the county and state level. Users can create customized reports with measures related to community socioeconomic characteristics, health outcomes, and health risks and behaviors, CAH service mix, community benefit spending, and more. Community characteristics data are also available for counties without CAHs so that CAHs can select counties that approximate their service area. Users can download a full report or generate customized reports with select measures.

Financial and Operational Improvement Data

The financial data portal in CAHMPAS offers several new features designed to assist State Flex Coordinators in monitoring CAH performance and developing and targeting Flex financial and operational improvement interventions.
  • State Flex Coordinators can view and save a chart showing predicted risk of financial distress for CAHs in their states over time. 
  • CAH executives can now download all of their hospitals' financial data in a .csv file using the "Reporting" feature.
  • State Flex Coordinators can now view a table showing state-level CAH reporting and performance on select financial indicators compared to national benchmarks or medians.
In addition, financial data have been updated to include financial indicator data for calendar year 2017, including predicted financial distress levels for 2019. These data can be used to compare performance among CAHs in your state and also to other custom groups of CAHs nationwide.

The financial portal in CAHMPAS requires a password and is only available to State Flex Coordinators and CAH administrators. Please email monitoring@flexmonitoring.org to retrieve your login information.
Rural Health Innovations Launches Network Sustainability Toolkit

Rural Health Innovations (RHI) announced in July their new online Network Sustainability Toolkit. The toolkit gives easy access to many tools that help rural leaders aim their networks toward sustainability and increase long-term impact. 

Use the Network Sustainability Assessment as a performance improvement tool that measures indicators of a sustained network. The assessment uses a validated set of questions identified by over 100 network peers.

For the past five years, RHI, working through Health Resources and Services Administration's (HRSA) Federal Office of Rural Health Policy (FORHP) contracts, has provided technical assistance to over 250 rural health networks. Their knowledge and understanding of rural health networks, coupled with a systems approach, a study of rural health networks, and concepts from the Baldrige Performance Excellence Framework, has led to the development of our Network Sustainability Toolkit, an online portal of resources.

The Rural Health Network Sustainability Assessment, an integral component of the Toolkit, was developed through a two-year study by RHI, the National Cooperative of Health Networks (NCHN), and Evalytics, LLC. The study was funded by the U.S. Department of Health and Human Services (DHHS), HRSA, FORHP. This project is being implemented in memory of Gwen Martin, PhD, founder of Evalytics, LLC. See the 2018 Network Sustainability Study: Final Report for additional background information.

For more information or questions about RHI, please contact Sally Buck at (218) 727-9390 ext. 225 or sbuck@ruralcenter.org.
 
Coming Up in August:

August Virtual Knowledge Group (VKG) -- Monday, August 5, 2019 from 2:00 p.m. - 3:00 p.m. Central Time.

Chronic Obstructive Pulmonary Disease (COPD) Manual Webinar
August TASC 90 Webinar -- Thursday , August 15, 2019 from 2:00 p.m. - 3:30 p.m. Central Time.

Flex Program Webinar hosted by FORHP -- Thursday , August 22, 2019 from 1:00 p.m. - 2:00 p.m. Central Time.

HELP Webinar -- Tuesday, August 27, 2019 from 12:00 p.m. - 1:00 p.m. Central Time.

TASC Updates

New Emergency Medical Services (EMS) Resources

In July, we were pleased to announce the availability of the Rural Community Ambulance Agency Transformation Self-Assessment resource. This resource was supported by FORHP and coordinated by TASC. Please share widely this resource with rural ambulance agencies and partners as appropriate.
This resource helps ambulance agency leaders in rural America assess their agency's readiness to transform to the level of care that is a people-centered and rewards positive patient outcomes through value-based payment. It provides assistance to rural ambulance agency leaders in succeeding with moving from volume to value in their agency's culture and operations.

Rural Community Ambulance Agency Transformation consists of a self-assessment and associated resource collections in the areas of the Critical Access Hospital Blueprint for Performance Excellence , adapted specifically for rural ambulance agencies, from the Baldrige Excellence Framework for Health Care. Leaders are encouraged to complete the assessment periodically to monitor their progress and receive updated resources to guide their continued journey. The self-assessment and resource collections include:
Rural Chronic Obstructive Pulmonary Disease (COPD) Podcast Series: Episodes #1-4 Out Now!

The National Rural Health Resource Center (The Center) has partnered with Dr. Bill Auxier of  Rural Health Leadership Radio   to produce a six-part podcast series about Rural COPD and its prevalence in rural America. This series from The Center provides information about COPD, how rural  providers are meeting the needs of their communities, and the importance of billing and coding appropriately while ensuring quality of care is being addressed. Each podcast features a guest with expert knowledge in COPD and rural health.
 
Coming Soon: E pisode 5   featuring Lindsay Corcoran and Laurie Daigle, Stroudwater Associates

  • On this episode, our speakers discuss the billing and coding considerations for hospitals and pulmonary rehab programs, the financial challenges hospitals with these programs face, opportunities for hospitals within their existing pulmonary rehab programs, where to find up-to-date financial resources on COPD programs, and the future of COPD care.
  • Lindsay Corcoran is an accomplished senior consultant and practice management professional with over ten years of healthcare and medical office experience. At Stroudwater Associates, Lindsay focuses on supporting and sustaining health care access for rural communities through hospital operational improvement and affiliation strategies, and has assisted rural and community hospitals and clinics across the country to improve operational and financial performance. Results-oriented and highly organized, Lindsay is a skilled and effective communicator with medical providers, patients, and administration.
  • Laurie Daigle, a senior consultant at Stroudwater Revenue Cycle Solution, is a certified professional coder with over 18 years of experience in medical insurance claim processing, medical billing software training, auditing, and health care financial management. She has years of experience as a manager for a national commercial payor, and extensive experience in health care management, from physician group practices to large academic institutions. She has been instrumental in the creation of Revenue Integrity resources to unify coding, billing, and compliance concerns for total and inclusive revenue cycle oversight. She has led successful initiatives to increase physician and departmental productivity, to improve business office efficiency and accuracy, and to develop policies and procedures for all areas within the revenue cycle.
Webinars, Recordings & Events

New and Updated Resources 

A full list of resources is available in the  TASC resource library
Many more resou rces can be found on the TASC website  by searching for key words in the search field. 
New Flex Monitoring Team Research
A full list of research can be found on the Flex Monitoring Team website.

 

Financial Policy Brief

The Flex Monitoring Team has published a  new brief comparing the characteristics of communities served by critical access hospitals (CAHs) predicted to be at high risk of financial distress to communities served by all other CAHs. Using data from 2017, the Financial Distress Index (FDI) model assigns CAHs to high, mid-high, mid-low, or low predicted risk levels for 2019 using Medicare cost reports and Neilsen-Claritas data summed to market areas.

CAHs predicted to be at high risk of financial distress were found to serve communities with significantly higher percentages of non-White individuals (Black individuals in particular), lower high school graduation rates, higher unemployment rates, and worse health status.

Rural Interview with CDC

The Centers for Disease Control and Prevention (CDC) is focusing on rural health. Take some time to read the RHIhub interview with CDC on their work with rural, and the need for storytelling and data collection.
 
Rural Health Leadership Radio  was launched to support rural health leaders to share stories and information about what is working and what is not. Check out their latest podcasts now! 

The most recent interviews are on the topics of agriculture and mental health, various aspects of rural health, PAs and NPs in CAHs, and HIV, immunization, and billing.



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