State Office Director Since 2013
Washington 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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Rural Health Quality Network (RHQN) - Assist critical access hospitals (CAHs) with submitting quality data via the Centers for Medicare and Medicaid Services (CMS) Abstraction and Reporting Tool (CART). Many of these facilities do not have the manpower resources or staff competency to abstract and report appropriate data. This work plan is designed to provide ongoing data abstraction assistance to RHQN members so that they can identify, develop and then sustain a process for reporting CART relevant data. This work plan calls for on-site visits, evaluation of charts, training of staff and logistical support for data input.
Rural Health Quality Network (RHQN) - Assist CAHs with completion of the Hospital Survey on Patient Safety Culture (HSOPSC) "Just Culture" survey and provide staff and management education on organizational culture. Twenty-eight of the thirty-fours RHQN member facilities have recognized the value of the HSOPSC Just Culture Survey to their provision of a patient safety culture and quality of patient care. RHQN management has already received Team Stategies and Tools to Enhance Performance and Patient Safety (STEPPS) instructor/trainer training. We will be able to provide specific classes using the Team STEPPS methodology.
Rural Health Quality Network (RHQN) - Provide infection prevention support to RHQN member CAHs whose infection preventionist is new, needs support and education or needs technical assistance with policies and protocols that promote patient safety and quality patient outcomes. Twenty-four of the thirty-four RHQN member CAHs have used the services of our infection prevention consultant.
Critical Access Hospital Network (CAHN) - Maintain a CAHN central data repository that allows access to patient data on an individual or population basis. CAHN facilities aim to provide advanced information management, data query and reporting capabilities across a variety of platforms used within the hospital and clinic facilities operated by the CAHN.
Critical Access Hospital Network (CAHN) - Commit staff and resources to ensure a central care coordination/ management system in CAHs and rural health clinics (RHCs). Health Systems will promote the development of: referral tracking, proactive transition of care and follow up. Support education/training programs for care coordinator. The goal of this project is to strengthen coordination between our rural CAH medical staffs and Spokane tertiary delivery systems. With FLEX 2011-12 funding, the CAHN aims to deliver services uniformly in a well-coordinated and efficient manner by creating and maintaining a care coordination infrastructure in the CAHs and their respective RHCs. This will include employing clinical care coordinators (CCCs), establishing written policies and procedures, and assuring the CCCs have the knowledge base to provide the most effective coordinated care.
North Olympic Peninsula Network - Support formal procedures to initiate a pilot model of large system affiliation on behalf of the three rural hospitals on the North Olympic Peninsula. Foster partnership among three public hospital districts and the two local health jurisdictions on the North Olympic Peninsula and support the development of a sustainable network to evaluate community health outcomes.
One recent development for the hospitals is a formal proposed affiliation with a large urban system in Seattle, Swedish Health Services, for tertiary care services. This affiliation may include a shared electronic medical record (Swedish's Epic System) which could greatly improve communication for individual patients and allow population health improvements. This affiliation will help to ensure that all needed health care services will be made available to all 100,000 residents of the North Olympic Peninsula, regardless of payment plan.
Washington State Hospital Association (WSHA) - Operational assessments for CAHs where the leadership feels their stand-alone organizational model is no longer viable. As part of the current Flex grant activities, WSHA is doing an assessment of CAH technical assistance needs. It is clear from the information garnered in interviews that the assistance needs of rural hospitals are rapidly changing.
Regional Critical Access Hospital Conference - The States of Alaska, Idaho, Oregon and Washington have for several years sponsored a regional CAH conference in Spokane, Washington. Three plenary sessions and nine break-out sessions are provided.
Washington State Hospital Association (WSHA) - Support continuing implementation of the Washington State Rural Strategic Plan. Part of the continuation of the Rural Strategic Planning work will be to support rural projects around the state that align with the Rural Strategic Plan, and develop a resource hub so communities can find examples and tools of how they can implement the plan in rural communities across the state.
Critical Access Hospital Network (CAHN) - The purpose of this project is to create formal linkages with specialists and urban tertiary centers. CAHN aims to identify and design an effective strategy for CAHs in Eastern Washington to respond to requirements of section3022 of the Patient Protection and Affordable Care Act (PPACA), the Accountable Care Organization (ACO).
Critical Access Hospital Network (CAHN) - This project continues the CAHN’s vision to strengthen a collaborative regional health care system by; 1) implementing the principles of care coordination among rural and urban settings and 2) promoting the health information exchange (HIE) to optimize quality health care and health outcomes. The aim of these efforts is to enhance the quality of care and test an infrastructure designed to stabilize and strengthen the local rural health care system.
The Critical Access Hospital Network (CAHN) which has several projects listed above has been hard at work for several years to improve care transitions between their rural facilities and providers and the tertiary physicians and facilities in Spokane. Rapid transport of chest pain patients to a cath lab and potential stroke patients to a tertiary neurologist have been addressed. Current work is on improved management of chronic disease patients with better information sharing and coordination between rural and tertiary settings. Nurse case managers have been employed for each rural facility and their medical staff. And, transfer protocols have been mutually developed. This work has been well received by both rural and urban providers.
North Olympic Peninsula - Last year the three rural hospitals on the North Olympic Peninsula developed a “request for proposal” (RFP) describing their interest in affiliating with a tertiary system. The RFP generated nine very thorough responses and one system was selected for further negotiation. Operating support agreements have been negotiated and approved with Swedish Medical Center in Seattle by all three of these public hospital districts and their boards. By taking the initiative themselves and working together these three facilities were able to generate significant interest from potential larger partners.
The Rural Health Quality Network (RHQN) which has several projects listed above has been providing “circuit rider” physicians to its 32 member hospitals for medical staff peer review. These facilities receive a quarterly visit from their physician reviewer. Prior to arrival, the reviewer requests that selected charts (based on high volume/high risk/changing standards of practice...) be provided. The reviewer then presents their findings directly to the medical staff in person and provides a summary to administration.