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Alabama Department of Public Health

Top Flex Activities

Program Area: Support for Quality Improvement

All Alabama critical access hospitals (CAHs) receive support for quality improvement through Alabama's Rural Quality Network (RQN). You can read more below regarding RQN and the activities surrounding RQN to support Flex hospitals.

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

Alabama has been fortunate to have 100% participation in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reporting. This high participation has been highlighted two years in a row by the Flex Monitoring Team State Data Reports. The national reporting rate is 81.2% and Alabama ranks #1 among the 45 states that participate in the Flex Program. Alabama’s CAHs have continuously scored significantly higher on two HCAHPS measures (Communication with Nurses and Pain Management), and have not had any significantly different performance on the remaining nine HCAHPS measures. Alabama’s CAHs have truly embraced HCAHPS and see the benefits of HCAHPS in improving patient care.

Program Area: Support for Financial and Operational Improvement

As a carryover from the fiscal year (FY) 2016-17 budget period, two CAH financial feasibility studies are being completed. The goal of these studies is to provide recommendations to improve the CAHs’ financial and operational performance and enhance the hospitals’ financial sustainability. The studies will also review the business side of the hospital and will include a review of financial, operational and clinical volume data. 

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care.

In May 2017, Alabama CAHs received a training session on value-based purchasing (VBP). This training was critical in providing the hospitals with a better understanding of the business side of their clinical operations, which is crucial to the hospitals' survivability. The goal of the training was to work with the hospitals so that they understood the formula of VBP as it relates to quality data collection, quality improvement measures, the Medicare Beneficiary Quality Improvement Project (MBQIP) and the impact those measures have on their bottom line and ultimate financial sustainability. The timing of this training was especially vital to Alabama’s hospitals, which are highly dependent on Medicare payments and are faced with major payment changes under the Medicare Access and CHIP Reauthorization Act. The training was well attended and conducted by a professional hospital consultant. A survey was also implemented to measure the effectiveness of the training.

Please provide information about network activities in your state to support Flex Program activities.

A major activity related to quality improvement in Alabama Flex has been the creation and development of the RQN. The RQN, which first met in May 2009, has been and continues to be the most popular and best-attended activity in the Alabama Flex Program. Alabama's RQN has set the stage for sharing information, developing strategies to meet needs and learning about best practices, with the overall goal of improving the quality of care in CAHs. Alabama Flex holds at least three RQN meetings each year.

RQN has created a platform for hospitals to receive professional and high-quality training, information, and networking opportunities with peers. RQN was started with 30 participants and is now up to 70 participants (with 100 percent participation). Hospital administrators are beginning to see the real value and importance of RQN and are now without hesitation granting approval for their staff to attend RQN meetings. A huge outcome of RQN has been the concrete and tangible things that attendees can take back with them and actually implement and see tangible results.

In addition to benchmarking and training, participating hospitals are usually asked to provide an action plan for something concrete they plan to do following the RQN meeting. Some of the action plans recently reported by hospitals include:

  • Developing and implementing a readmission assessment tool
  • Re-educating the staff on and enforcing bedside rounding
  • Improving the medication reconciliation process
  • Improving patient education

Please describe how your state Flex Program has enhanced its use of data in the past year.

The Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) tool is used often and is highly recommended. The CAHMPAS tool is very helpful in assisting state office staff with monitoring the CAHs' financial indicators. One of the goals of the Alabama Flex Program is to "move the needle" on the state's CAH financial indicators; having knowledge and information on where the CAHs stand financially is very useful. With CAHMPAS it is possible to compare Alabama CAHs to other states as well as review national averages and trends. Being able to collect data out of CAHMPAS also helps to guide the Flex program on areas of training for financial improvement.

Do you have any hospitals interested in converting to CAH status?


Program Statistics

Type of Government State Government
Staffing 3.0 FTEs
Number of CAHs 4
Website URL Organization Website

Flex Program Staff

Chuck Lail
State Office Director, Alabama
(334) 206-5396

Specialty Areas / Background

  • Information technology
  • Program management
  • Rural health development

State Office Director since July 2005

Michael Smith
Flex Coordinator, Alabama
(334) 206-5649

Flex Coordinator since March 2018

Jane Knight
Flex Co-Director, Alabama
(334) 272-8781

Specialty Areas / Background

  • Alabama Hospital Association
  • Rural Hospitals Program Manager
  • Flex Program management

Flex Co-Director since January 1999

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,100,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.