Medicare Rural Hospital Flexibility Program ORHP Update 2010 Oklahoma Rural Hospital Conference

1. Medicare Rural Hospital Flexibility Program ORHP Update2010 Oklahoma Rural Hospital Conference Steven Hirsch Public Health Analyst Department of Health and Human Services Health Resources and Services Administration

2. What is Going on in Washington?

3. What’s New at ORHP?

4. “Within the total amount requested for Rural Health activities, the Budget includes $79 million to continue the President’s initiative to improve rural health. The goal for of this initiative is to improve the access to and quality of health care in rural areas.

5. Health Workforce Recruitment and Retention Building a Programmatic “Evidence-Base” Telehealth/HIT Coordination Cross Governmental Collaboration The Improving Rural Health Initiative: Key Elements

6. Office for the Advancement of Telehealth • New Addition to ORHP … • Telehealth Network Grants • Telehealth Resource Centers • Licensure and Portability

7. Office for the Advancement of Telehealth • Linking with the Rural Initiative • Helping link Telehealth Grantees with other ORHP Grantees • Promoting the Telehealth Resource Centers to Rural Communities • Linking with USDA Distance Learning and Telehealth Programs

8. Telehealth Resource Centers

9. Telehealth Grant Opportunities • Telehealth Network Grant Program • Guidance available late Spring • Eight awards Expected by September • Telehealth Resource Centers • Guidance available late Spring • Seven awards by September

10. HIT and Clinical Information Resources • National Network of Libraries of Medicine • http://nnlm.gov/funding/ • Agency for Health Research and Quality • http://healthit.ahrq.gov (click on Health IT in Small and Rural Communities) • USDA Distance Learning and Telemedicine • http://www.usda.gov/rus/telecom/dlt/dlt.htm • National Library of Medicine Applied Informatics Program • http://www.nlm.nih.gov/ep/GrantInfoSys.html • FCC’s Rural Health Care Corporation • http://www.fcc.gov/ccb/apd/ruralhealth/

11. HIT and Rural • Challenges Ahead • Incentive Payments and “Meaningful Use” • Possible Resources • ORHP grants • Findings from CAH-HIT Evaluation • HIT Resource Centers

12. ORHP & Key Rural Program

13. Policy and Research • Regulation Review • Regular Medicare payment updates • Value-Based Purchasing and Quality Reporting • HIT Meaningful Use • Demonstrations • Frontier Extended Stay Clinics • Frontier Payment Integration

14. Policy and Research • Rural Health Services Research • Six Rural Health Research Centers • Three Policy Analytic Resources • Links with Agency for Health Research & Quality

16. ORHP Community-Based Grant Opportunities for 2010-2011 • Small Health Care Provider Quality Improvement • 60+ Awards by September • Network Planning • Guidance out July; Applications Due October • Next Year • Network Development Guidance Available on http://www.grants.gov

17. Grants Technical Assistance Workshops Michigan North Dakota Wisconsin

18. Hospital-State Division: Building an Evidence Base New Flex Guidance Re-Focusing SHIP East Morgan County Hospital, a CAH in eastern Colorado

19. Flex Program:

20. Flex Program: The Multi-State Project A Focus on Medicare Beneficiary Outcomes Voluntary Project Using Common Focus Area and Metrics

21. New Manual • FQHC-CAH Collaboration • Statutory Background • Case Studies

22. Resources for CAHs in 2009 • Capital Planning • Prototype Design • Capital Planning Manual (coming) • For more information, contact Bridget Ware 301-443-0835 http://portal.hud.gov/portal/page?_pageid=73,1827038&_dad=portal&_schema=PORTAL (Click on CAH Planning, Design and Construction Guide)

23. Flex Program Goals • Development of State Rural Health Plan (SRHP) • Designation of CAHs in the State • Development and Implementation of Rural Health Networks • Improvement and Integration of EMS Services • Improving Quality of Care

24. Flex Program Guidance • Support for Quality Improvement • Flex Programs are required to support efforts to improve and sustain the quality of care provided by CAHs • Health information technology (HIT) can be used as a tool to help improve the quality of care provided by CAHs.

25. Support for Quality Improvement • Encourage CAHs to publicly report data to Hospital Compare on relevant process of care quality measures for inpatient and outpatient care, and HCAHPS patient experience of care survey results. • Support participation of CAHs in a multi-hospital QI project. This project should address a priority QI need identified using quality data from CAHs in your state. • Support CAH participation in quality reporting and benchmarking initiatives other than Hospital Compare (e.g., state and multi-state CAH quality networks). • Support CAHs in implementing a multi-hospital quality/patient safety project focused on leadership and organizational culture (e.g., Team STEPPS, AHRQ patient safety culture surveys).

26. Support for Quality Improvement • Support QI education/training programs for managers, staff and/or board members of CAHs. • Identify CAH technical assistance (TA) needs related to implementation of electronic health records (EHRs) and health information exchanges (HIEs) and link CAHs to TA resources to address the identified needs. • Support CAHs in developing arrangements to share HIT infrastructure and/or IT staff with other CAHs, referral hospitals, and/or health care providers. • Support initiatives to train CAH clinicians and staff in meaningful use of EHRs, related technologies (e.g., computerized order entry; clinical decision support for high priority conditions) and HIEs. • Optional Multi-Grantee Special Project on Medicare Beneficiary Health Status Improvement.

27. Flex Program Guidance • Support for Operational and Financial Improvement • Flex Programs are required to support efforts to improve CAH financial and operational performance improvement.

28. Support for Operational and Financial Improvement • Assist CAHs in identifying potential areas of financial and operational performance improvement (e.g., financial and operational condition assessments; coordination of network and user group meetings for CFOs and managers to discuss operational and financial issues; review of CAH financial indicator reports). • Support CAHs in planning and implementing evidence-based strategies for improving financial performance (e.g., charge master reviews; revenue cycle improvement; recovery audits; cost report evaluations; increased charge capture; maximizing Medicaid reimbursement; managing billing, collection, charity care and bad debt policies; group purchasing; and accessing capital).

29. Support for Operational and Financial Improvement • Support CAHs in planning and implementing evidence-based strategies for improving operational performance (e.g., development of productivity benchmarks; centralization of ancillary services; departmental efficiency improvement; scope of services assessment; board leadership; collaborative recruitment and retention strategies; staff productivity management; LEAN management; TeamStepps; balanced scorecard implementation; supply management systems; integration of materials management billing, purchasing, and patient information systems; and work environment and workflow improvement). • Develop and provide the infrastructure for multi-hospital collaboratives that support CAHs in planning and implementing evidence-based strategies for improving operational and financial performance.

30. Flex Program Guidance • Support for Health System Development and Community Engagement • Flex Programs are required to support efforts to assist CAHs in developing collaborative regional or local systems of care, addressing community needs, and integrating EMS in those regional and local systems of care.

31. Support for Health System Development and Community Engagement • Support CAHs, communities, rural and urban hospitals, EMS, and other community providers in developing local and/or regional health systems of care. • Support the inclusion of EMS services into local and/or regional systems of care and/or regional and state trauma systems.

32. Flex Program Guidance • Facilitate Conversion of Small Rural Hospitals to CAH status • In accordance with current statute, State Flex Programs are expected to facilitate appropriate conversion of small rural hospitals to critical access status. Flex programs must assist hospitals in evaluating the effects of conversion to critical access status.

33. Rural Workforce Issues: ORHP and Beyond The Rural Recruitment and Retention Network www.3rnet.org

34. Rural Workforce Issues: ORHP Pilots • The Rural Training Track Technical Assistance Center • Guidance Now on Grants.gov • The Rural Network Training Grants • Guidance Expected Soon A Family Medicine resident in Idaho

35. http://nhsc.hrsa.gov/communities/apply.htm http://nhsc.hrsa.gov/loanrepayment/apply.htm

36. Rural Workforce Issues • Nursing Loan Repayment • http://bhpr.hrsa.gov/dsa/nsl.htm • Nursing Scholarships • http://bhpr.hrsa.gov/nursing/scholarship/

37. Rural Workforce Issues: Linking to Other HRSA Programs • Health Careers Opportunities Program • http://bhpr.hrsa.gov/grants/diversity.htm • Nursing Programs • Advanced Education • Traineeships • Nurse Education, Practice and Retention • Nursing Workforce Diversity http://www.bhpr.hrsa.gov/nursing

38. Rural Assistance Center • Web-Based Services • http://www.raconline.org • Electronic Updates Subscribe on the website • Customized Assistance • Phone: 1.800.270.1898 • E-mail: info@raconline.org

39. Health Workforce Information Center • Web site - Easy access to key information on over 50 workforce topics and 80 professions, including: • Events & training • Organizations • Funding • News and Updates • Resources • HWIC Call Center • 1-888-332-4942 • info@healthworkforceinfo.org healthworkforceinfo.org

40. Contact Information Steven Hirsch Public Health Analyst 301-443-7322 shirsch@hrsa.gov http://ruralhealth.hrsa.gov