Idaho Flex State Profile
The Technical Assistance and Services Center (TASC), a program of the National Rural Health Resource Center, provides technical assistance for the Rural Hospital Medicare Flexibility (Flex) Program in the form of information, tools and resources. State Flex Programs benefit from sharing information with one another and the Flex State Profiles are meant to be a method to encourage that sharing.
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- Encourage Idaho critical access hospitals (CAHs) to participate in Medicare Beneficiary Quality Improvement Project (MBQIP) and use the identified measures to target specific interventions within Idaho.
- Encourage Idaho CAHs to publicly report to Hospital Compare on relevant inpatient, outpatient, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data.
- Use Idaho CAH work groups and networks to identify specific quality benchmarking and quality improvement activities.
- Support CAH participation in quality reporting and benchmarking initiatives other than Hospital Compare.
- Actively work toward raising staff awareness about patient safety and the identification of areas of strength and potential needed improvements.
- Support CAH educational opportunities on patient safety and quality improvement for CAHs.
- Assist critical access hospitals (CAHs) in identifying potential areas of financial and operational performance improvement by conducting financial and operational assessments.
- Increase Idaho CAH staff ability to better manage their revenue cycles.
- Support Idaho CAHs to create an efficient and compliant charging mechanism through chargemaster review.
- Provide billing and coding education to help prepare CAHs for ICD-10 conversion.
- Support the spread of “Lean Transformation” techniques to Idaho CAHs.
- Support critical access hospitals (CAHs), communities, emergency medical services (EMS), and other community providers to develop local systems of care by implementing a community case study process.
- Conduct rural EMS agency medical director education, which includes EMS agency administrators, in three CAH communities.
Clearwater Valley Hospital and Clinics in Orofino received Flex 2011 funds to redesign hospital discharge procedures with several improvements in quality of care. The primary innovation was an “opt-out” approach to visiting nurse services (VNS) upon hospital discharge. The new critical access hospital (CAH) protocols include the following elements:
- When patients are admitted to the hospital, they are triaged for risk at discharge.
- Medication reconciliation is performed within 24 hours of admission.
- The presence of one of five factors triggers a referral to VNS upon discharge and a follow-up appointment within seven days of discharge.
- Medication reconciliation within 24 hours of admission increased from a baseline of 61% to a high of 84%.
- Risk assessments performed on 84% of patients upon admission.
- Up to 77% of high-risk patients have VNS visits within 48 hours of discharge. Over 85% consistently have visits within a longer time frame after discharge.
- Most significantly: 30-day readmission rates dropped from 20% to 7%.
The risk assessment tool, including prompts for medication reconciliation and VNS referral, are now part of our hospital EMR workflow. The new workflows are being adopted by another CAH, St. Mary’s Hospital in Cottonwood.
State Contact Details
Specialty Areas / Background
Mary is a registered nurse. Her specialty areas include rural emergency medical services, nursing, health care quality, and patient safety.
State Office Director and Flex Coordinator since October 2003
Health Program Specialist Since June 2011