|
|
|
|
|
|
|
Hello Everyone!
I hope you are enjoying the beginning of summer.
We are gearing up for the 2016 Flex Program Reverse Site Visit. Registration is now open, details and links below. The topic this year is Communicating Value and Opportunities. I'm excited to see everyone and meet all the new people.
The Book Club has begun. Please see below for details. I was fortunate enough to meet Dr. Amit Sood, the author of our first book club book at the Minnesota Rural Health Conference. He was one of the keynote speakers at the conference and spoke about resilience. It was great to hear him share his message and suggestions in person and have an opportunity to speak with him afterwards.
In the TASC Tasks section you will see a mention of the Subject Matter Expert Technical Assistance phone call opportunity. Don't miss the chance to spend an hour speaking to an expert. There is a range of topics. Please let me know if you have any questions.
Please enjoy the photos from our gracious contributors. Feel free to send any pictures you happen to take along your travels.
Caleb Murphy Siem, MH
Program Specialist
Technical Assistance and Services Center (TASC)
|
|
|
Welcomes and Farewells
Welcome to Nicole Linn, Flex Coordinator, Florida and Rebecca Dobert, Field Services Coordinator, Oregon.
Farewell to Mary Beth Brown, Flex Program Quality Improvement Coordinator, Washington and Jeana Christensen, Flex Coordinator, Iowa
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.
|
|
CMS Issues More Information on Pause of QIO Two-Midnight Review
The Centers for Medicare & Medicaid Services (CMS) has provided additional information on its temporary pause of Quality improvement Organization (QIO) claim audits under the two-midnight inpatient admissions policy impacting critical access hospitals. |
 |
| | Sarah Young, FORHP |
Dear Flex Folks,
On Monday, June 27th, the Federal Office of Rural Health Policy (FORHP) welcomed a new member of the Flex Team. Owmy Bouloute comes to us from a Centers for Disease Control and Prevention (CDC) Rosenfield Global Health Fellowship in Mozambique. He has a Master's degree in public health and a Doctorate in pediatric medicine. Christy Edwards and Yvonne Chow have done a great job supporting extra grantees since Kevin Chaney left, but we are all glad to return to a full complement of four Flex project officers (POs).
As you saw, the June MBQIP Monthly has a great story about Petersburg Medical Center in Alaska. The dedicated team in Petersburg successfully reports all of the Medicare Beneficiary Quality Improvement Project (MBQIP) measures, including Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures, with an average census of less than one patient per day. Great job Petersburg! This story is a wonderful example of the value of the work you all do to help rural hospitals and communities.
A couple of reminders based on things we've seen in your Flex progress reports:
- OP-4 and OP-18 are required MBQIP measures in the new grant year. As Robyn Carlson from Rural Quality Improvement Technical Assistance (RQITA) explained in the March MBQIP Monthly, OP-4 and OP-18 must be reported or the QualityNet warehouse will reject other outpatient data. Be sure you are including OP-4 and OP-18 in your work plans and contracts for the upcoming grant year. Any questions about the data submission process, contact
- Data, data, data... As you know, all of us - hospitals, rural projects, state offices and federal grant programs - face increasing expectations to show our value. For you as state Flex Coordinators this means a focus on reporting data for the project measures that you selected in your grant applications. I realize collecting and reporting data is not easy and it's never perfect. As project officers we will work with you to help you report your data. You have two opportunities every year to report data that reflects the accomplishments of your state Flex Program: the progress report (NCC) and the Performance Improvement Measurement System (PIMS) data report. We want your progress reports to meet this expectation to report data, that's why we often ask you to make changes. The progress report is very individual, highlighting your work in your state, while the PIMS data (which will be reported in September and October) provides aggregate measures for the national Flex Program. I'm working with our IT contractors to reformat PIMS to reflect the update to national Flex measures. More to come on that effort this summer.
I was lucky to join the Region A Partnership Meeting earlier this month in Portsmouth, New Hampshire. I really enjoyed hearing more about the work of the State Offices of Rural Health (SORHs) and how some of you are using multiple approaches to work with rural hospitals and rural communities. One challenge we discussed at the meeting that probably resonates for many of you is helping rural hospital leaders and rural communities to understand how the US health care system is changing. That's a huge topic without an easy answer! Rural Health Value is one resource that FORHP supports to help you and your rural stakeholders understand and navigate these changes. Many of TASC's products and other tools from The Center can also help you help people in your states.
The Reverse Site Visit (RSV)will be here before you know it! I'm looking forward to seeing you all at the RSV on July 20-21 here in Rockville, Maryland. TASC sent out information by email recently about hotel and event agenda, registration is open now.
Do you use the HRSA Grants website? The Health Resources and Services Administration (HRSA) Office of Federal Assistance Management (OFAM) oversees grant activities and award processing and maintains this section of the website to provide information for grantees. The Grants section has links to new funding opportunities across HRSA and to the Grants Forecast to help you predict upcoming announcements that may be of interest to your partners and stakeholders. The website also has tools to manage your grant including the EHB Knowledge Base with Electronic Handbook (EHB) tutorials and help topics.
Sarah
Federal Office of Rural Health Policy (FORHP)
|
|
| | Marsh Marigolds Courtesy of Burton Laine, husband of Deb Laine, Program Specialist at The Center |
|
CAH Regulatory Update
Proposed Rule: Advanced Practice Registered Nurses
The Department of Veterans Affairs (VA) published a proposed rule that aims to expand the scope of practice of advanced practice nurses (APRN) - certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and certified nurse-midwives - who work for the agency in order to provide veterans with greater and timely access to care.
Rural community providers have the opportunity through this proposed rule to inform the VA of rural considerations in expanding APRN authority. Comments must be submitted by July 25, 2016.
Medicare Shared Savings Program; Accountable Care Organizations-Revised Benchmark Rebasing Methodology, Facilitating Transition to Performance-Based Risk and Administrative Finality of Financial Calculations
On June 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published a final rule revising the Medicare Shared Savings Program (MSSP), in which providers and suppliers that participate in an Accountable Care Organization (ACO) may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. The final rule changes the savings calculation formula by phasing in regional fee-for-service expenditures into the methodology for establishing, adjusting and updating the benchmarks for ACOs that continue participating in MSSP after an initial three-year agreement period; adds a participation option to encourage ACOs to transition to performance-based risk arrangements; and provides greater administrative finality around the program's financial calculations.
Of interest to rural ACOs considering applying to MSSP in 2017 is the new participation option. Currently, most MSSP ACOs have agreements under Track One, which is a one-sided model that limits risk. Eligible ACOs that participated under the one-sided model for their first agreement period may apply to continue in Track One for a second agreement period, or apply to a two-sided model. Under the final rule, CMS has added an option for ACOs participating under Track One to apply to renew for a second agreement period under a two-sided model (Track Two or Track Three), which includes risk. If the renewal request is approved, the ACO may request that its initial participation agreement under Track One be extended for an additional year (that is, the ACO would enter a fourth performance year under Track One). As a result of this deferral, CMS will defer rebasing the ACO's benchmark for one year. At the end of this fourth performance year under Track One, the ACO will transition to the selected performance-based risk track for a three-year agreement period. This option will become available beginning with the 2017 application cycle. More information on the application cycle is available through the Shared Savings Program's website.
Proposed Rule: Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility and Improvement in Patient Care
On June 13, 2016, CMS displayed a proposed rule to make changes to the Medicare and Medicaid Conditions of Participation (CoPs) for all hospitals and critical access hospitals (CAHs). The current hospital CoPs are codfied in regulation at 42 CFR Part 482 while the CAH CoPs are at 42 CFR Part 485, Subpart F. The CoPs are further interpreted by CMS in the State Operations Manual which provide guidance to hospital surveyors on the CoPs and tells hospitals and CAHs what to expect at their surveys.
|
|
MBQIP Highlights
There has been a flurry of activity around the Medicare Beneficiary Quality Improvement Project (MBQIP) recently, including new federal proposal for critical access hospital participation in quality reporting (see the next article for more information). A few new resources have been developed and a number of familiar resources have been updated.
MBQIP Participation Requirements Clarified
On March 16, 2016, the Federal Office of Rural Health Policy (FORHP) announced the minimum MBQIP requirements for CAHs wishing to participate in any Flex funded activities heading in to the second year of this grant cycle. In short, CAHs must have a signed MBQIP Memorandum of Understanding (MOU) on file with FORHP and have submitted MBQIP measure data for at least one measure for at least one quarter or complete a waiver explaining why they did not report. The Flex Eligibility Criteria for MBQIP Participation provides greater detail on the requirements and a sample waiver template is available.
New Required MBQIP Measures
On March 16, 2016, FORHP announced the addition of two required MBQIP measures starting in fiscal year 2017:
- OP-4: Aspirin on Arrival
- OP-18: Median Time for Emergency Department (ED) Arrival to Departure for Discharged Patients
These two measures are part of the broader outpatient measure sets for acute myocardial infarction (AMI)/chest pain and ED throughput, respectively. QualityNet requires that all measures in a measure set be submitted in order for any data to be accepted, so although these measures are not technically required until next fall, it is strongly encouraged that hospitals not already reporting these measures, begin doing so as soon as possible.
Changes to Outpatient Reporting Deadlines
New versions of both Inpatient and Outpatient CART have been released: CART Inpatient 4.17.1 and CART Outpatient 1.13.1. Both available on the QualityNet website.
MBQIP Monthly
MBQIP Monthly messages for state Flex Programs and CAHs began again in January, 2016 and are distributed via email with the most current version always available on the MBQIP Monthly webpage.
RQITA and the Technical Assistance and Services Center (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 meant for state Flex Program personnel and designated contractors. The next MBQIP VKG call is scheduled for September 15, 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.
|
|
Proposed Rule: Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care
Significant proposed changes for CAHs include standards for:
* Maintaining a data-driven quality assessment and performance improvement (QAPI) program
* Written non-discrimination policies
* Regularly evaluating the care provided by practitioners at the CAH
* Maintaining active infection prevention, infection control, and antibiotic stewardship programs
Of particular note for CAH stakeholders, the discussion of CAH QAPI programs recognizes the FORHP-supported Flex Medicare Beneficiary Quality Improvement Project (MBQIP) as a national quality measurement and reporting program. The proposed rules would require CAHs to collect data to measure the quality of care they provide and CAH participation in MBQIP is one way for CAHs to meet this data collection requirement. Rural stakeholders and CAHs should review the proposed rule and submit public comments before August 15, 2016. Specific, actionable comments and suggested alternatives related to identified policies can help CMS develop the final regulation for CAHs and hospitals.
|
The Technical Assistance and Services Center (TASC) is working on a variety of tools, resources and products to support the state Flex Programs and critical access hospitals (CAHs). Below is a brief summary of work under development that will soon be released!
- Registration is still open for the 2016 Flex Program Reverse Site Visit. There is no cost to attend the event, but you must register. Please register online at https://www.ruralcenter.org/tasc/2016/reverse-site-visit. Room block has closed. If you have question about the Reverse Site Visit, please contact Jere-lyn Fern at [email protected]
- Please don't miss the opportunity to participate in a no-cost opportunity for a 60-minute, one-on-one Subject Matter Expert (SME) Technical Assistance call. Please submit your request form by July 15 to Caleb at [email protected] and TASC will work with you and the SME to set up the call. Send any questions to Caleb at [email protected]
- TASC is putting the finishing touches on a Contract Management Guide which will be released shortly - stay tuned!
- The next TASC 90 webinar is August 10, 2:00 p.m. - 3:30 p.m. (CST). The topic will be Strategies for Rural Provider Engagement in the Health Care Transition
- Please see the details below about the Book Club
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.
|
|
| | Portland Japanese Garden by Bridget Hart, Program Assistant, National Rural Health Resource Center |
|
|
CMS Project Seeks Innovative Hospital Quality Practices to Share Nationwide
The Centers for Medicare & Medicaid Services (CMS) invites hospitals to submit innovative quality improvement practices to its Strategic Innovation Engine, which will evaluate them for possible dissemination across the nation. Targeted improvements include:
- Managing patients with multiple chronic conditions
- Engaging patients and families as active members of the care team
- Coordinating care within and across settings
- Streamlining patient flow
- Integrating behavioral health into care
Organizations whose practices are selected will be recognized and celebrated nationally. For more information, contact [email protected] or e-mail [email protected]. The American Hospital Association Health Research & Educational Trust affiliate is a partner in the initiative.
|
2016 Flex Program Reverse Site Visit
The Flex Program Reverse site visit is coming up in just under one month on July 20-21, 2016 in Rockville, MD. The theme for this years event is Communicating Value and Opportunities. The Reverse Site Visit is a great opportunity for state Flex Program grantees to convene and share information about the Medicare Rural Hospital Flexibility (Flex) Program and critical access hospitals (CAHs). This even will focus on the latest information and issues in the Flex Program including discussion on how national changes in healthcare delivery will impact CAHs. States will share stories of their Flex Program experiences and successes with one another and with their project officers at the Federal Office of Rural Health Policy (FORHP) during regional project officer meetings. We look forward to your attendance at what is sure to be an informative and enjoyable event.
Registration is currently open, and there is no charge to attend the event. Please find more details, a draft agenda as well as registration on the TASC website. |
|
New and Updated Resources
The following resources on the Technical Assistance and Services Center (TASC) website are new or recently updated:
Author: Rural Health Innovations
This presentation highlights the trends in health information technology (HIT) professional roles in rural HIT, challenges of HIT professional recruiting as well as provides examples of best practices.
Author: Rural Health Value
Discusses the movement from cost-based reimbursement toward value-based purchasing in health care.
New Rural Health Value Resources
Author: Rural Health Value
This new model from the Center for Medicare & Medicaid Innovation will offer value-based payments to primary care practices. This document provides a summary of CPC+, as well as rural considerations and implications.
Author: Rural Health Value
Based on the results of roundtable discussions with rural and frontier innovators, this paper offers themes, strategies and perspectives on overcoming challenges related to health care innovation in rural communities. A summary of innovations across a variety of rural and frontier organizations is included.
Author: Rural Health Value
Summit Pacific Medical Center, a critical access hospital (CAH) in Elma, Washington, is proactively advancing value-based care and approaching payors for value-based payment contracts. This new Rural Health Value profile highlights their five-prong approach to developing value-based capacity.
Author: Rural Health Value
Rural health care leaders report challenges when trying to educate and engage board and community members regarding health care organization changes required to succeed during the volume-to-value transition. Yet, value-based care discussions should play a significant role in all strategic planning and should be included in organizational performance measurement.
New/Updated MBQIP Resources
Author: Stratis Health
This guide and toolkit offers strategies and resources to help critical CAH staff organize and support efforts to implement best practices for quality improvement.
Author: Stratis Health
This guide is intended to help Flex Coordinators, CAH staff and others involved with MBQIP understand the measure reporting process. For each reporting channel, information is included on how to register for the site, which measures are reported to the site and how to submit those measures to the site.
Author: QualiyNet
The Centers for Medicare & Medicaid Services (CMS) Abstraction & Reporting Tool (CART) is used for inpatient and outpatient data collection and analyses to inform quality improvement efforts. CART is available from QualityNet for use on a stand-alone, Windows-based computer, in a computer network or in environments without computing resources (paper tool). The application is available at no charge to hospitals or other organizations seeking to improve quality of care.
Author: QualityNet
The quality reporting specifications manuals are uniform guidelines defining hospital inpatient and outpatient data to be collected and how data is to be reported. They contain the information necessary for abstractors to ensure data are standardized and comparable across hospitals. Because updates to the manuals are necessary over time, find the data collection time period for which you are reporting and select the associated specifications manual.
Author: Stratis Health
The MBQIP Measures Fact Sheets provide an overview of the data collection and reporting processes for the fiscal year (FY) 2015 Medicare Beneficiary Quality Improvement Project (MBQIP) required measures. The goal of this resource is to capture details regarding the MBQIP measures and provide them in a basic, one-measure-per-page overview. The intended audience for these fact sheets is CAH personnel involved with quality improvement and/or reporting and state Flex Program personnel.
Author: Stratis Health
The following template is for state Flex Coordinators to tailor as needed and send to critical access hospitals (CAHs) reminding them of upcoming data submission deadlines for Medicare Beneficiary Quality Improvement Project (MBQIP) measures, as well as corresponding collection time periods and submission processes.
|
|
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. This is a great opportunity to learn from each other.
Please note, you will need to login to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact TASC. |
|
AHA, CDC Issue Patient Education Resource on Prescription Opioids
The American Hospital Association (AHA) and the Centers for Disease Control and Prevention (CDC) released a one-page resource to help hospital patients who may be prescribed opioids before discharge discuss the risks and benefits of these medications with their health care provider. "Every day, hospitals see how misuse of and overdose from prescription opioids affects patients' families, loved ones and communities," said AHA President and CEO Rick Pollack. "We want patients to have open, honest conversations with their care providers about the best way to manage pain. The goal is to help patients manage their pain and continue to lead health, productive lives. We are pleased to work with the CDC to develop and share this new resource with hospitals and care providers across the county." Representative Hal Rogers (R-KY), Chairman of the House Appropriations Committee and co-Chair of the House Caucus on Prescription Drug Abuse, and Representative Annie Kuster (D-NH), co-Chair of the Bipartisan Task Force to Combat the Heroin epidemic, applauded the tool.
|
|
Book Club
Thank you for your interest in the Book Club. TASC is asking interested participants to purchase or borrow selected books as they are able. The Mayo Clinic Guide to Stress Free Living by Dr. Amit Sood is our first book for anyone who is interested in participating we are using the Flex Program Forum as our platform for discussion. We have begun discussing the first two chapters (33 pages) below you will find the first discussion post on the text, posted by Caleb. Please visit the Forum to participate in the conversation.
"The first two chapters of this text really hooked me. The piece I connected to the most was the discussion of habit and default mode. There is a similar concept in phenomenology, one of the areas in philosophy I'm interested in. Phenomenology studies (among other things) the 'habit body' and examines the way we, and our bodies interact with and in the world.
What were the things you most connected to?"
If you have any questions or would like to suggest a book title, please don't hesitate to reach out to Caleb Murphy Siem.
|
|
Quality Measures and Sociodemographic Risk Factors: The Rural Context
Researchers and policymakers have publicly discussed and debated whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is a nuanced understanding of how adjustment should be conducted within a rural context and what impact it might have on patients and providers when quality measures are used for bench marking and payment. The purpose of this project was to identify how rurality and key sociodemographic variables might affect quality-of-care outcomes and to estimate the potential impact on quality measurement.
State Variations in the Rural Obstetric Workforce
The overall frequency and increasing rate of obstetric units closures in rural hospitals raises concerns about access to obstetric care among rural women, who experience poorer health outcomes than their urban counterparts. Rural hospitals face obstetric unit staffing challenges due to day-to-day variability in the census of obstetric patients, and as well as challenges with retention, recruitment, training and scheduling of obstetric clinicians. Many types of staff are necessary to successfully run an obstetrics unit. Across both urban and rural settings, there is regional variation in the types of clinicians attending deliveries. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington and Wisconsin.
Surgical Quality Gap Narrow for Critical Access Hospitals Versus Other Hospitals, JAMA Study Shows
A recent study published in the Journal of the American Medical Association (JAMA) suggests the gap in quality between critical access hospitals (CAHs) and non-CAHs may not be as wide as originally thought.
State Innovation Models (SIM) Initiative: A Report on the Role of SORHs
Seventeen states have received State Innovation Models (SIM) funding either in Round One or Two to test state-led, multi-payer health care payment and service deliver models. Round One Test Awards are in the final years of demonstration, while Round Two Test Awards are in the second year of funding. The National Organization of State Offices of Rural Health (NOSORH) reached out to State Offices of Rural Health (SORHs) to get an update on rural initiatives within state SIM plans in these states along with the involvement of SORHs in the implementation of these initiatives. This report provides a description of the overall state initiatives and the SORHs support of the projects. |
|
| | Missouri Barn, courtesy of Melissa Van Dyne, Rural Health Manager, Missouri |
|
|
Webinar Playbacks and Event Materials
Are you looking for resources in the topics of: strategies for the new health care era, quality improvement, the Flex program core competencies, rural health transformation, Flex Program orientation or Health Information Technology workforce networks? Look no further!
Network
- Allied Health Networks
- Network Development
- HIT Workforce Networks
- Network Planning
|
|
| | Sally Buck, CEO, The Center and Dr. Amit Sood, The Mayo Clinic, (author of our book club book, The Mayo Clinic Guide to Stress Free Living) at the 2016 Minnesota Rural Health Conference |
|
|
CAH Recognition
Thank you everyone for your suggestions for the next round of critical access hospital (CAH) Recognition topics. We are currently reviewing the suggestions and working with the Federal Office of Rural Health Policy and will be announcing shortly the topic for the next round. Thank you all who sent in suggestions, if you have any questions please send Caleb an e-mail at [email protected] |
|
|
National Rural Health Resource Center Blog
|
|
Grow your Career: Save the Dates
Below is a list of upcoming events relevant to rural health:
Technical Assistance and Services Center (TASC)
2016 FORHP Flex Program Reverse Site Visit
July 20-21, 2016 in Rockville, Maryland. Registration and details available on the TASC website!
TASC 90 Webinar
August 10, 2016 2:00 p.m. - 3:30 p.m. Central Time
Federal Office of Rural Health Policy (FORHP) and Technical Assistance and Services Center (TASC) updates
Critical access hospital (CAH) Regulatory updates
Topic: Strategies for Rural Provider Engagement in the Health Care Transition
Check the TASC Events page for upcoming events.
View upcoming rural events by month, state or keyword search.
|
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!
|
|
|
