Flex Program Directive

1. ND Nursing Research ConferenceND Center for NursingOctober 23, 2014ND Hospital Quality Reporting Efforts

3. Flex Program Directive Support efforts to improve and sustain the quality of care provided by CAHs to ensure that rural citizens receive high-quality, appropriate care in their communities.

4. ND Medicare Rural Hospital Flexibility (Flex) Program Flex Program Core Areas

5. Flex Support to ND Critical Access Hospitals (CAHs) for Quality Improvement • Collaboration with Large and Small Hospitals

6. ND CAH Quality NetworkEstablished in 2008 • 100% ND CAH Participation • Executive Committee Members (8 CAHs) • Advisory Committee Members • Staff - North Dakota Center for Rural Health

7. ND CAH Quality Network • The mission of the Network is to support ongoing performance improvement of North Dakota's Critical Access Hospitals • Virtual Library of Shared Tools • Conditions of Participation • DON Mentorship Program • Quarterly Newsletter • CAH Event Reporting • State Stroke Program • Medicare Beneficiary Quality • Improvement Program

8. Medicare Beneficiary Quality Improvement Program (MBQIP) and Critical Access Hospitals (CAHs) Nationwide • 94% are participating in MBQIP (1,240 CAHs) • 81% are reporting inpatient measures (1,074 CAHs) • 52% are reporting outpatient measures (688 CAHs) • 55% are reporting HCAHPS (732 CAHs)

9. Maintain CAHs Publicly Reporting Data to Hospital Compare • MBQIP streamline efforts for hospital inpatient and outpatient data reporting and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) • Quarterly technical assistance webinars • Benchmark statewide and individual CAH data • Highlight high performers and share best practices • Medicare Hospital Compare www.medicare.gov/hospitalcompare

10. The Quality Measures Crosswalk

11. Center for Medicare and Medicaid (CMS) Hospital Inpatient Public Reporting Heart Failure • HF-1 Discharge Instructions • Numerator : Heart failure patients with documentation that they or their caregivers were given written discharge instructions or other educational material addressing all of the following: • 1. activity level • 2. diet • 3. discharge medications • 4. follow-up appointment • 5. weight monitoring • 6. what to do if symptoms worsen

12. CMS Hospital Inpatient Public Reporting Heart Failure • HF-2 Evaluation of LVS Function • Numerator Statement: Heart failure patients with documentation in the hospital record that LVS function was evaluated before arrival, during hospitalization, or is planned for after discharge.

13. CMS Hospital Inpatient Public Reporting Heart Failure • HF-3 ACEI or ARB for LVSD • Numerator: Heart failure patients with documentation in the hospital record that Left Ventricular Systolic function was evaluated before arrival, during hospitalization, or is planned for after discharge.

14. Congratulations to Carrington Health Center! • 3 Year High Performer on Bundle of Care for Heart Failure (HF) • HF-1 Discharge Instructions • HF-2 Evaluation of LVS Function • HF-3 ACEI or ARB for LVSD

15. Questions? Contact information Jody Ward, RN, MS, APHN Senior Project Coordinator University of North Dakota School of Medicine and Health Sciences, Center for Rural Health jody.ward@med.und.edu