Alabama State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

Alabama’s Rural Quality Network (RQN)

The Flex grant provides funding and logistics for hospitals to receive professional training, information, best practices and networking. Core Measure scores are captured, benchmarked and used to identify best practices to be shared. Quality projects are determined annually by the group, with this year’s focus to continue benchmarking the selected core measures of benchmarking and improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores. All hospitals are required to share quality data in order to participate in the RQN. The RQN is the favorite Flex activity, and the networking further facilitates sharing in many areas, promoting growth and improvement by participating hospitals.

During 2015-2016, RQN participants attributed the following results to participation in the network:

  • Better understanding of Core Measures and why they are important
  • Improved transition of care from the critical access hospitals (CAHs) to other health care settings to improve patient outcomes
  • Improved patient safety in hospitals and communities by ensuring all health care providers and eligible patient populations received their influenza vaccination
  • Improved HCAHPS scores through utilization of teach back
  • Better understanding of the effects of sepsis through education

Medicare Beneficiary Quality Improvement Project (MBQIP)

The CAHs meet prior to the RQN for MBQIP networking, where unblinded data is shared and training is provided by consultants to promote quality improvements in targeted areas.

Please share a success story about reporting quality data or using quality data to help Critical Access Hospitals (CAHs) in your state improve patient care: 

The following is a success story from one of Alabama’s CAHs located in Blount County, as reported by their Director of Nursing:

The greatest impact for St. Vincent’s Blount has been the MBQIP emergency department transfer communication (EDTC) measure. Prior to acknowledging and reporting EDTC, Blount treated skilled nursing facility (SNF) transfers like a discharge home. Since the beginning of reporting, Blount has greatly improved communication with the community's four nursing homes upon transfer of the patient. In addition to improving verbal communication, this improved awareness of returning imperative documentation to the SNF, such as medications received in the Emergency Department (ED). Thorough communication has improved the transition in care from the ED to the SNF.

Program Area: Support for Financial and Operational Improvement: 

Hospital sustainability is at a crisis level in Alabama, with six Flex/Small Rural Hospital Improvement Grant Program (SHIP) hospital closures since 2009. The Financial Improvement Network (FIN) was created to provide the tools needed for sustainability assessment and improvement for CAHs and small rural hospitals. In FY 2015, the FIN focused on chargemaster review. The chargemaster is a foundational cornerstone of a hospital’s revenue cycle. Participating hospitals were required to submit their chargemaster in an electronic format. As a result of immediate findings, each hospital was able to implement positive, sustainable changes to their chargemaster creation, maintenance and review processes. This was done through a collaborative process between the administration and revenue-producing departments.

Program Area: Support for Designation of CAHs: 

The Alabama Flex Program is currently working with one hospital that is looking into converting to CAH status.

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

The Alabama Flex Program will begin working with CAHs on transitioning to value-based care this coming grant year, utilizing SHIP carryover funds.

Please provide information about network activities in your state to support Flex Program activities (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

The RQN has been meeting since October 2009 and remains the favorite activity of the Flex/SHIP hospitals. The RQN has grown from presenting information to processing data and providing improvement practices. Twenty-eight hospitals are currently participating in the RQN. Participants appreciate the "take home" items provided, such as specifics on how to improve core measures and how to reduce readmission rates.The FIN began in December 2013, and data already exists to show improvements in some financial indicators being measured and promoted, such as net patient revenue, net accounts receivable and days cash on hand. The FIN is a crucial Flex activity to help hospitals improve financial management and sustainability, as six small, rural hospitals have closed in Alabama since 2009.

Since the inception of the FIN, existing data show improvements in some financial indicators being measured and promoted, such as net patient revenue, net accounts receivable and days cash on hand.

Both networks are made up of CAHs and other rural providers who agree to share their respective data with the network. Sharing is critical, as professional consultation provides benchmarking and the sharing of best practices and improvement tools. Both networks focus on specific activities within the Flex Program areas and on areas of mutual concern.

Please provide information about cross-state collaborations you may be working on related to the Flex Program: 

The Alabama Flex Program is administered through the State Office of Rural Health (SORH) in collaboration with the Alabama Hospital Association (AlaHA). Co-directors in both agencies work together to provide leadership, management and guidance to the program, which serves the four CAHs and 27 other rural providers across the state. The Flex Program recognizes all SHIP-eligible hospitals as participants and invites all hospitals to all activities, provided the hospitals are willing to share requisite data. Both co-directors collaborate with the Alabama Quality Assurance Foundation, the quality improvement organization (QIO) for Alabama, to promote the objectives of all programs and to ensure duplication of effort is avoided. Collaboration also exists within Region B with other state Flex Programs, as well as with the Flex Monitoring Team (FMT). Areas of mutual interest and concern are shared, multiplying the effect of positive activities and reducing the damage of negative events.

From the last Flex Program year, please describe a best practice you would like to share with other states: 

Both the RQN and the FIN continue to serve as best practices in Alabama. The CAHs and other rural providers have seen significant improvements in both their quality and financial arenas due to the networking and the professional consultation provided through the Flex grant. Networking allows the cost-benefit of providing consultation to a group of hospital staff, rather than one-on-one consultation. The consultation improves the overall status of many hospitals across the state, while networking encourages relationship-building between hospitals.

Program Statistics

What type of organization is your Flex office housed in?: 
State Government
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

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

Gloria Davis
Flex Co-Director, Alabama
(334) 206-5649

Specialty Areas / Background

  • Alabama Office of Rural Health
  • Former Outreach Director for Alabama's Children's Health Insurance Program
  • Former Medicaid Enrollment Manager for Alabama's Department of Youth Services
  • Licensed Masters of Social Work

Flex Co-Director since December 2016

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.