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Hello everyone,
I hope you all have had excellent start to your fall season so far! It's starting to get a little cooler up here in Duluth, but I think we will be safe from blizzards and sub-zero temperatures for at least another month.
It was great getting to see some of you at the National Rural Health Association (NRHA) Critical Access Hospital (CAH) Conference last week. We are also looking forward to meeting with some of you next week for the
October Flex Workshop
.
As always, I hope you enjoy this month's edition of Rural Route. We appreciate you taking the time to read it. If you have any questions or need anything, please reach out to myself or TASC.
Thank
s,
Andy Naslund
Program Coordinator
Technical Assistance and Services Center (TASC)
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Welcome to
Sarah Andersen
of Oregon.
We are happy to have you as part of Flex!
We bid a fond farewell to Cynthia Snyder of Kansas and Megan Hartwig of Iowa. We wish you both well!
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Federal Office of Rural Health Policy (FORHP) Updates
Updates Include:
- We are in the middle of Performance Improvement and Measurement System (PIMS) reporting. Please read the Fiscal Year (FY) 2018 PIMS Instructions to make sure we are all collecting PIMS data in the same way.
- If you encounter long load times with PIMS, please send me an email with the date and time, what page you were trying to access, what browser you were using, and a description or screenshot of the problem.
- PIMS also had some glitches in the first week of September. I believe those issues are fixed, but of course let us know if you run into any more problems.
- Space
- Yvonne Chow, our Medicare Beneficiary Quality Improvement Project (MBQIP) Coordinator and fellow Flex project officer has left HRSA. We will miss her knowledge and enthusiasm! We will be bringing on a new MBQIP Coordinator. In the meantime, I will be covering MBQIP issues with the expert help of the Rural Quality Improvement Technical Assistance team at Stratis Health.
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New CMS Final Rules Impacting CAHs
Space
The Centers for Medicare and Medicaid Services (CMS) just issued two final rules impacting CAHs that will be published on September 30, 2019. Please see below and watch for more information soon.
- Adds discharge planning as a condition of participation for CAHs in 42 Code of Federal Regulations (CFR) § 485.642
- Effective 60 days after publication
- Adds infection prevention and control and antibiotic stewardship programs as conditions of participation for CAHs in 42 CFR § 485.640
- Revises 42 CFR § 485.641 to require a quality assessment and performance improvement program as a condition of participation for CAHs.
- Effective dates:
- CAH Quality Assurance Performance Improvement (QAPI) requirements - 18 months after publication
- Hospital and CAH compliance with the antibiotic stewardship requirements - six months after publication
- All other requirements, including those for patient's rights - 60 days after publication
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Comments Requested: Rural Access to Health Care Services
Space
HRSA seeks information from the public about measuring access to health care in rural communities. This Request for Information (RFI) supports the ongoing work of the
Department of Health and Human Services (HHS) Rural Health Task Force that is seeking to identify the needs of rural communities, how to meet those needs, and what HHS policy changes can address those needs. Questions for public comment specific to rural communities include: what are the core health care services needed, what types and numbers of health care professionals are needed, what factors are important to identify core health services, and how should access to health care services be measured. People in rural communities
face a range of health disparities, including greater obesity and disease burden in children and adults, higher mortality rates, and shorter life expectancy. Rural areas also have
fewer health professionals per person compared to urban areas.
Response Date: October 9, 2019
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Critical Access Hospital (CAH) Recognition: Ellenville Regional Hospital, Ellenville, New York
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Ellenville Regional Hospital
(ERH), located in Ellenville, New York, is recognized for implementing an innovative project to fight the opioid crisis in collaboration with a federally qualified health care center (FQHC
). The Opiate Reduction Medicaid Accelerated Exchange Series Pilot (Max) Project has provided a new model of care in an effort to decrease the administration of opioids in the Emergency Department (ED
). The Max Project decreased administration of opioids to chronic pain patients who were shown to be super-utilizers of the ED
, while also connecting them to primary care and specialty services provided at the FQHC
, such as pain management and mental health.
Positive Accomplishments
- Of the 64 chronic pain patients in the pilot project:
- ED utilization decreased by 72.8 percent
- Administration of opioids in the ED decreased by 84.4 percent
- Overall opioid administration in the ED decreased by 42.5 percent (excluding the chronic pain cohort).
Top Accomplishments
The Max Project provides an ongoing effective model of collaborative care to ensure continuity of care for patients. The project has provided model intervention lessons which integrate prevention and treatment. This project also addresses New York's prevention agenda priority area to promote mental, emotional, and behavioral (MEB) health along with the prevention of substance abuse and other MEB disorders.
"Rural hospitals have to reinvent themselves to better meet new paradigms in health care and to create value. Our transformation from a 95 percent inpatient model to 75 percent outpatient includes substantial focus on population health with special emphasis on fighting the opioid crisis. Ellenville Regional Hospital is deeply appreciative of being selected for this prestigious recognition." - Steven L. Kelley, CEO
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Coming Up:
Space
The October workshop will be held October 1-3, 2019 in Duluth, Minnesota.
Flex webinar -- Monday, October 7, 2019 from 2:00 p.m. - 3:00 p.m. Central Time. (Rescheduled from 9/16)
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TASC Updates
Space
Chronic Obstructive Pulmonary Disease (COPD) Supplemental Project
Last week at the National Rural Health Association's Critical Access Hospital Conference, Caleb Siem of TASC was part of the COPD Session "Chronic Obstructive Pulmonary Disease - Improving Quality of Life Within Your Community" along with Steve Barnett, DHA, McKenzie Health System, Kristi Martinsen, FORHP, and Carla Wilbur, DNP, Stroudwater Associates.
From left to right: Kristi Martinsen, Caleb Siem, Carla Wilbur, Steve Barnett.
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COPD Resources
In August, we were pleased to announce the release of the new COPD Guide:
A Rural Hospital Guide to Improving Chronic Obstructive Pulmonary Disease.
Make sure to go check out the new
Rural COPD Resources and Efforts
page on the Center website to find a collection of materials that came out over the past few months. Also, be on the lookout for Episodes 6A and 6B of the
Rural COPD Podcast
.
For questions about the COPD project, email Caleb Siem.
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
CAH 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:
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The Takeaway: Rural Communities Struggle to Continue Providing Emergency Medical Services
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Last month in
The Takeaway
, produced by Public Radio International (PRI) and WNYC, they looked into the occasionally high costs of paying for out of network ambulance services. To avoid those expensive bills, some listeners reported they opted for ride-sharing apps instead of calling 9-1-1.
Space
But in rural United States, using Uber and Lyft is far less practical, regardless of situation. Although many rural communities depend on emergency medical services, operating an ambulance in these areas comes with a unique set of challenges.
Space
To get a better understanding of how emergency medical services operate in rural areas, The Takeaway was joined by Andy Gienapp, the state EMS manager for Wyoming.
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New from SRHT
Space
Watch the short video featuring Summit Panelist Interviews
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Population Health for Rural Hospitals: What the experts are saying
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Summit Findings Report and the Rural Hospital Guide to Improving Care Management
The
Summit Findings Report will assist rural hospitals, clinics and network leaders in considering key actions that they can undertake to incorporate community care coordination planning as a strategy to help position the organization for population health.
The
Rural Hospital Guide provides rural hospital executive and management teams with generally accepted best practice concepts related to care management. Explore opportunities to improve performance within the hospital setting through the transition from traditional fee-for-service reimbursement to a value-based, population-health-focused reimbursement environment.
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Webinars, Recordings & Events
Webinar Playbacks
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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.
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MBQIP Updates
Space
Updated Resources
Please send your MBQIP questions to the
[email protected]. TASC will ensure your question reaches the appropriate person.
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Flex Monitoring Team Research
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.
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Rural Interview with CDC
The 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.
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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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