Top Three Flex Activities in 2009

1. QIO/CAH Quality Collaborative
2. Recruitment and Retention Support
3. Performance Measurement/Clinical and Operational Performance

Flex Program Success Story

Tennessee's Critical Access Hospitals have had the opportunity to participate in a quality improvement project focusing on improving hospital clinical care to patients with heart attacks, heart failure and pneumonia. These clinical measures are part of the measurement set proposed by both the Centers for Medicare and Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for national comparison reports. Participation also allows Critical Access Hospitals to benchmark their performance against state, regional, and national averages in addition to peer group comparisons. The project includes quarterly abstraction of clinical data submitted electronically for data analysis and comparative bench marking. Educational workshops and conference calls are also conducted throughout the year.

• For the CAHs that have been abstracting and submitting clinical measure data to the Quality Improvement Organization (QIO) Warehouse, the goal was to improve care on one clinical measure.
• CMS performance goal: as a group, the CAHs must achieve a 10% reduction in the failure rate (RFR) on at least one clinical measure. There is the potential to earn extra "credit" for a 20% RFR.
• Additional goals:
  • Encourage all CAHs to not only abstract and submit data, but also to act on the data with a common-measure QI project, and to agree to publicly report their data
  • Collaborative sharing of Quality Improvement (QI) "journey" and best practices
  • Engage leadership, front line staff, and physicians

Key Results

• All 16 CAHs now report their data to the Clinical Warehouse
• 12 CAHs publicly report their data on HospitalCompare
• efforts to increase participation are enhanced through encouraged participation in the Quality Collaborative, a networking approach of sharing quality improvement best practices
• The 6 CAHs that were part of the CMS quality improvement group achieved a 38% RFR on the pneumonia immunization measure working collaboratively with the other CAHs

Most Significant Achievement

The Centers for Medicare and Medicaid Services (CMS) notified the state of Tennessee's Medicaid Program (TennCare) in late 2003, that it had approved a critical access hospital (CAH) supplemental pool of up to $10 million dollars. Tennessee submitted amendments to the operational pool incorporating the methodology and describing the operating provisions applicable to making special payments to CAHs and also distributed approximately $5,000,000 to seven CAHs during FY 05. These payments increased to approximately $10,000,000 during 2006 and an additional $15,000,000 during 2007-08.

Flex Program Details

The Tennessee Department of Health (TDH) is the Flex Program grantee and relies on the expertise of the Tennessee Hospital Association (THA). Through a contractual agreement, THA assists rural hospitals in the designation of critical access hospitals and provides technical and regulatory support.

THA has provided

• technical assistance necessary to assist rural hospitals during the conversion process;
• interpretation and consultation regarding federal rules, regulatory requirements and reimbursement, including Medicare Conditions of Participation;
• state licensure and certification standards;
• quality and performance improvement;
• accreditation assistance;
• federal and state advocacy;
• and legislative support.

The utilization of the Tennessee Hospital Association to facilitate the CAH designation process in Tennessee has been very successful.

Number of CAHs: (17) and (1) in the process of converting to a CAH.
Web site: http://www.tha.com (General Flex Program Info from THA)

State Rural Health Plan
Rural Assistance Center State Resources