Flex State Profiles
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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In each core area, what are the top Flex activities in your state?
Core Area 2: Support for Operational and Financial Improvement
Financial assistance is being provided to seven CAHs that applied for chargemaster review, cost report evaluation and/or health information technology assessment contracts to improve financial and operational outcomes. Hospitals receiving the contracts must provide quarterly reports on the issues identified, progress made on improving the issue, and any improvements being seen.
MORH will host an annual conference focusing on all the Flex core areas for CAH leaders. CAHs who have successfully implemented an operational and financial improvement project and developed a high-school aged recruitment program will be highlighted. Other presentations include the United States Department of Agriculture's Rural Development Program speaking about their services; National Rural Health Association providing a legislative update; University of Missouri-Columbia Health Care Center discussing the impact of adverse events on medical providers; Pharmacy Support Services Support Center providing information on the 340B Drug Program and the Nebraska Values Collaborative showing the impact of employees taking ownership can have on health care delivery.
- Leadership Institute Series.
- Rapid improvement events utilizing lean process management.
- CFO networking.
- Coding education.
- Administrator meetings and Critical Access Hospital (CAH) Nursing Director Forum.
- Scholarships for CAH staff to attend statewide professional meetings for Health Information and Management Systems (MT-HIMSS), Medical Staff Support (credentialing) (MT-AMSS) and Health Information Management (MHIMA).
- Use Flex Monitoring Team (FMT) data to assist struggling CAHs.
- Development of a CAH utilization review network
- Ensure CAH regulatory compliance
Good financial performance is also based on the elements in the Baldrige model. For example, good leadership and open communication throughout the organization will enhance both operational and financial improvement. The key activities under this area are:
- Providing training and education to critical access hospitals (CAHs) on Lean Management techniques. Once training has been completed, monitor and provide technical assistance on the implementation of Lean Projects. Thus far 14 CAHs are receiving or have completed the training and have implemented at least one Lean Project
- Conduct a comprehensive financial and operational assessment for low or negative margin CAHs. Once the assessment has been completed, a tracking system has been developed to assess the progress and changes in meeting the recommendations contained in the report. Thus far ten assessments have been completed and a total of at least four more will be done by the end of 2013.
Recognizing the need to create more effective, long-term solutions, health care financial leaders developed a process known as revenue cycle management. Through the use of comprehensive measurement and reporting, all hospital processes and employees are monitored, measured, and altered for optimum performance. Consistent with revenue cycle management, new tools are implemented to drive work performance and to optimize the use of existing information technology. To address revenue cycle problems faced by rural hospitals in Nevada, the Nevada Flex Program, through its Flex and Small Rural Hospital Improvement Grant Program (SHIP) subcontract with Nevada Rural Hospital Partners (NRHP), will continue implementation of the Nevada Rural Hospital Revenue Cycle Initiative initiated in previous budget periods. The program involves a complete review of the flow of patient financial information (PFI), the functions involved in the processing of PFI, and the identification of needed revisions. To assist in the monitoring of the effectiveness of the program, facility-specific reports and dashboards have been developed by NRHP to review the results of accounts receivable and to identify key trends assessing the effectiveness of rural hospital business offices. The goal of the revenue cycle initiative is to provide this service to any requesting rural and frontier hospitals in Nevada.
Support critical access hospitals (CAHs) in planning and implementing the Financial Improvement Network (FIN) to employ evidence-based strategies for improving financial performance and supporting CAH team participation in Lean/performance improvement training.
The NM Flex Program will support critical access hospitals (CAHs) in planning and implementing evidence-based strategies for improving operational performance through partnership with NMMRA, as well as through the efforts of New Mexico Health Resources (NMHR). NMHR, a current contractor under the state Rural Primary Health Care Act, will sponsor educational programs/seminars to this end, as well as provide support for hospital administrators to attend out-of-state activities such as the National Rural Health Association (NRHA) Annual Conference. These educational programs and seminars provide opportunities for CAH staff to increase and enhance their financial and operational skills, as well as continue to build on the relationships established in the Quality Improvement Network.
Currently there are three active Carolina Lean collaboratives with a total of 18 rural hospitals participating in three-year projects to transform the culture of their organizations. While this can be seen as a quality improvement “tool,” the reality of Lean is that when it is done correctly, it changes the way the hospital operates as the culture of the organization embraces systematic, ongoing improvement. The most successful hospitals have seen multi-million dollar returns on these efforts and the entire staff is engaged in improvement like never before. The NC Office of Rural Health & Community Care believes that Lean Management requires a change in culture beyond the implementation of Lean tools and that it is the future of health care management. The NC Office of Rural Health & Community Care is also doing work to help hospitals facilitate transition to meaningful use, providing for consultative support, and plan development.
- Assist CAHs in identifying potential areas of financial and operational improvement.
- Support revenue cycle management analysis to increase hospital revenue and cash flow.
The Quality Improvement (QI) Network also has focus on operational and financial performance. The Ohio Flex provided critical access hospitals (CAHs) with comparison data and analysis on operational and financial performance indicators well beyond the standard measures often reported. CAH CEOs and CFOs came together to provide in-depth financial data and identified indicators that were most meaningful to them. Once again they were able to look at current data and benchmark on a variety of levels that included all hospitals nationwide, CAHs nationwide and Ohio CAHs.
In efforts to support Ohio CAHs in financial and operational improvement, eight Ohio CAHs received in-depth revenue cycle assessment and technical assistance last year. Participating hospitals received one-on-one consultation to include at minimum two on-site visits, cost report analysis, revenue recovery assessment, charge master analysis and coding education. This year an additional three hospitals will receive financial consultant services.
The Oklahoma Flex Program will provide feasibility studies for hospitals on an as-requested basis. In the Fall of 2012, Oklahoma succesfully launched a collaborated conference with our rural health association and primary care association. In addition, hospitals are also able to participate on webinars hosted by our state's hospital association.