Core Competency: Improving Financial Sustainability

Changing market forces and payor reimbursement have been challenges for decades. Market forces continue to evolve and contribute to financially stress small rural hospitals. This financial distress has led to the closure of numerous rural hospitals while several hundred are currently classified as financially distressed. Similar to QI, state Flex Programs are not expected to be financial and operational improvement experts. However, state Flex Programs should have a basic understanding of financial and operational improvement principles to best support project partners, serve as a resource, develop project plans, establish, and implement initiatives, share best practices, and report program outcomes. They should also know how and where to access financial and operational technical expertise, such as TASC, and access and use financial data, such as CAHMPAS.

PROFICIENCIES: 

  • Recognize the basic concepts of CAH and rural health clinic (RHC) payment
  • Understand how CAH financial data are reported, analyzed, and acted upon
  • Describe what each of the most important CAH financial measures means, and how each affects the hospital’s overall financial performance
  • Explain the basic concepts of value-based payment for rural providers
  • Analyze a rural hospital’s financial performance over time and identify hospitals in financial crisis and in danger of closing
  • Understand the basic strategies for improving the financial performance of rural hospitals and clinics
National Rural Health Resource Center logo

Small Rural Hospital and Clinic Finance 101 Guide

National Rural Health Resource Center

FMT logo

​​CAH Financial Indicators Report: Summary of Indicator Medians by State

The Flex Monitoring Team

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Related Resources

Toolkit

Core Competency: Addressing Community Needs

It is important for state Flex Programs to understand the community needs of CAH and RHC service areas to develop or leverage program activities in support of health system development, community engagement, and population health improvement.
Toolkit

Core Competency: Understanding the Current and Future Health Care Environment

State Flex Programs can help CAHs transition into value-based systems, population health models, and future opportunities through education, network support, facilitation of new partnerships, and technical assistance.
Toolkit

Core Competency: Strengthening Quality Reporting and Improvement

State Flex Programs must understand QI principles, resources, and trends to support CAHs in advancing QI.
Toolkit

Core Competency: Understanding Policies and Regulations

State Flex Programs need to have an in-depth understanding of the policies and regulations governing the Flex Program, as well as a basic understanding of the policy-making process and other policies and regulations affecting rural providers.
Toolkit

Core Competency: Building and Sustaining Partnerships

State Flex Programs remain vital because of the web of relationships developed and maintained within communities, providers, networks, states, regions, and nationally. It is imperative that state Flex Programs have the skills, capacity, and commitment to build and sustain partnerships, new and old, to support rural providers and rural stakeholders.

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