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Alabama Department of Public Health

Top Flex Activities

CAH Quality Improvement

Alabama’s critical access hospitals (CAHs) participated one quarterly network meeting with the Rural Quality Network (RQN), where participants worked to address specific quality measures. Hospitals shared best practices and tools to address the Emergency Department Transfer Communication (EDTC) and Medicare Beneficiary Quality Improvement Projects (MBQIP) measures along with Hospital Compare measures. Alabama’s CAHs have been participating in the voluntary nationwide Swing Bed Quality Pilot Project. Through this in-person meeting and webinars, Alabama’s CAHs have improved standards of care and are successfully returning discharged patients to their communities. Internal quality reporting has also improved as a result of this project.

CAH Operational and Financial Improvement

Flex funds are utilized to assist CAHs with feasibility studies on a rotating basis. Financial feasibility studies, conducted by a national consultant, are in-depth reviews of the hospital’s cost report resulting in recommendations to improve the financial and operational performance. Participation in the swing bed project also addressed the impact of swing beds and the financial bottom line of hospitals. A four-part cost report training webinar series was hosted by a consultant for CAHs to be able to expand their knowledge of completing the cost report and the impact the cost report had on reimbursement rates.

CAH Population Health Improvement 

Through discussion at RQN, the Alabama Flex Program identified the need to address educational efforts for diabetic patients. An educational webinar was developed by the Alabama Department of Public Health’s Diabetes Program to be made available to patients of the state’s CAHs and other small rural hospitals. Fact sheets were also made available digitally for hospitals to print and distribute to patients or direct them to digital links. By providing diabetes self-management tools to patients, efforts can be made to manage their condition, improve health, and prevent them from unnecessary hospital visits.  

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

A major activity of Alabama’s Flex Program is the RQN, which first met in 2009, and has continued to be the most attended and requested activity of 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 Alabama’s CAHs and also benefitting the Small Rural Hospital Improvement Grant Program (SHIP) eligible hospitals. RQN started with 30 participants and is now up to more than 75 participants (with 100% participation). Hospital administrators are confident in the significance of RQN participation and continue to grant approval for their staff to attend meetings and for the data to be un-blinded. A valuable benefit of the RQN has been that hospital leaders gain insight and tangible data from the benchmarking of peer group hospitals that can be internally implemented for future outcomes.

This year, the RQN hospitals also participated in Learning Action Networks (LAN) through the RQN. The LANs included leadership rounding, emergency preparedness, capturing discharges, and care transitions and continue to build upon progress that has been made thus far.

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

The Alabama Flex Program is working closely with the newly established Alabama Rural Health Collaborative, located within the University of Alabama at Birmingham and has a seat on the Collaborative’s board of directors, and will be instrumental in identifying the technical assistance of the state’s 36 small rural hospitals and developing infrastructure and plans to address those needs.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1.4
Website Organization Website
Number of CAHs 5

Flex Program Staff

Stanley Woodson
Flex Coordinator, Alabama
(334) 206-5441

Flex Coordinator since April 2022

Karl Bryant
State Office Director, Alabama
(334) 206-5517
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, $1,560,000 (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.