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Arizona Center for Rural Health

Top Flex Activities

CAH Quality Improvement

The Arizona Flex Program (AzFlex) continues to provide training and education to Arizona’s critical access hospitals (CAHs) on the Medicare Beneficiary Quality Improvement Project (MBQIP) by monitoring and evaluating data, creating and disseminating reports to CAH leadership, and reviewing best practices so that Arizona can get to and sustain 100% MBQIP reporting. Activities include quarterly webinars with the Arizona CAH Quality Network; onsite technical assistance site visits to educate and assist CAHs in MBQIP; monthly MBQIP reminders and tips; customized reports with hospital scorecards on the MBQIP domains; and a quality lListServ to support CAHs and share best practices.

CAH Operational and Financial Improvement

AzFlex is working with the Arizona Hospital and Health Care Association (AzHHA) to address financial and operational issues. At each meeting, they will invite one of their CAH subject matter experts to present best practices they have successfully used or implemented at their facilities to address identified topics. Following the presentation and discussion, next steps will be identified as well as follow-up with hospitals. Follow-up will focus on practices that have been implemented, or if not, what steps would need to be taken to implement the practice or process. Consultants will be used as appropriate to augment in-house expert presentations. This year AzFlex collaborated with Southern Arizona Hospital Alliance (SAHA), Stroudwater Associates and hospital leadership, to develop a performance improvement network comprised of healthcare providers that service the southern Arizona geographic region. 

CAH Population Health Improvement 

AzFlex will assist Arizona CAHs to address existing health needs as identified through 2016-2018 community health needs assessments (CHNAs) through community collaboration and integration with statewide health initiatives. The health needs include: access to care; behavioral health services, healthy lifestyle factors, and the needs of an aging population.

Rural Emergency Medical Services (EMS) Improvement 

AzFlex continues to collaborate with the Arizona Department of Health Services (ADHS) Bureau of Emergency Medical Service (EMS) and Trauma System, and the 40 trauma centers (Level I, III and IV) in the state. The Arizona Trauma Managers Work Group has been meeting regularly for over seven years and continues to meet face-to-face quarterly, rotating through trauma center sites around the state. Over 100 people actively participate in a Trauma Program Manager listserv that is managed and maintained by Arizona Flex to share ideas, policies, best practices, etc.

AzFlex will provide training and support to EMS agencies located in CAH communities to utilize results from the 2016 Needs Assessment to enhance local EMS capacity.

They will promote and provide assistance to EMS agencies to participate in Arizona’s web-based pre-hospital registry (based on the EMS Needs Assessment conducted in 2016).

AzFlex also will collaborate with the Arizona Department of Health Services Bureau of EMS and Trauma System to assess and support the quality of services identified

If your Flex Program was funded for one of the eight competitive Flex EMS awards, please describe your project, your partners, and intended long-term outcomes.

Arizona Rural EMS Advanced Telemedicine Demonstration Initiative (AzREADI) will improve access to high-quality EMS care by implementing a rural, EMS-based telemedicine program linked to board-certified emergency medicine physicians. Recent improvements in wireless broadband capability (FirstNet), allow rural EMS agencies to extend communications and facilitate comprehensive, real-time vital sign patient telemetry and diagnostics to board-certified EMS physicians. The established Arizona Treat and Refer system, with its Medicaid cost recovery, and the proposed AzREADI platform will be timely, feasible, effective, and sustainable. AzREADI is being piloted with two rural EMS agencies with the goals of reducing unnecessary and/or long-distance ambulance transports, assuring high quality and sustainable pre-hospital care, and improving patient satisfaction. 

Two rural EMS agencies serving southern Arizona will work with the University of Arizona (UA) Department of Emergency Medicine and the Arizona Rural Hospital Flexibility Program to implement a telemedicine demonstration program (AzREADI), test its ability to improve rural EMS care, and decrease unnecessary air transport costs. The two partner EMS agencies are the Rio Rico Fire and Medical District, serving the rural area just north of the Arizona-Mexico border, and the Sonoita-Elgin Fire District, serving rural communities between Tucson and Sierra Vista, Arizona. The UA Department of Emergency Medicine provides medical director oversight for both. Their EMS service areas include 19,941 Arizona citizens and spans 792 square miles in southern Arizona.

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

As mentioned in the financial and operational section, AzFlex is working with the Arizona Hospital and Health Care Association (AzHHA) to address financial and operational issues in a program called the AzCAH Leadership Group Project.

AzFlex contracts with the AzHHA to run the Quality Network to help AZ CAHs in reporting MBQIP measures. The focus in past years has been to get CAHs just to report. Now with most reporting, AZHHA is working on improvement measures.

And lastly, the AzFlex runs a State Trauma Managers workgroup. This group meets quarterly and works on supporting and improving trauma programs statewide.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Yes. One hospital received its CAH designation in October of 2021 and one additional hospital is awaiting designation from CMS.
Type of Organization University
Staffing (FTE) 3.5
Website Organization Website
Number of CAHs 16

Flex Program Staff

Daniel Derksen, MD
Director, Center for Rural Health, Arizona
(520) 626-3085

Specialty Areas / Background

Director of the Center for Rural Health (CRH), Walter H. Pearce Endowed Chair and Professor, Director of the Community, Environment and Policy Division at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. As CRH Director, he oversees the State Office of Rural Health, the Rural Hospital Flexibility Program (Flex), and the Small Rural Hospital Improvement Program (SHIP). He chaired the American Academy of Family Physicians Commission on Governmental Advocacy in 2013-14. He served on the American Hospital Association’s Governing Council Section on Rural or Small Hospitals, and on the Arizona Hospital and Healthcare Association Small Rural Hospital Constituency Group.

Associate Vice President for Health Equity, Outreach & Interprofessional Activities; Office of the Senior Vice President for Health Sciences, The University of Arizona

Senior Advisor and PI, Arizona Area Health Education Center Program

Walter H. Pearce Endowed Chair & Director, Arizona Center for Rural Health 

Professor of Public Health, Medicine & Nursing, The University of Arizona

State Office Director since July 2013

Jill Bullock
Flex Coordinator, Arizona
(520) 626-3722

Specialty Areas / Background

  • Network development
  • Physician outreach
  • Healthcare program navigation and Medicaid eligibility 

Associate Director since September 2011

Joyce Hospodar
Manager, Health Systems Development, Arizona
(520) 626-2432

Specialty Areas / Background

  • Health services research including quality improvement and health systems development
  • Health planning
  • Network development

Senior Advisor, Rural Programs since 2001

Bryna Koch
Special Projects Coordinator/Internal Evaluation, Arizona
(520) 626-6253

Specialty Areas / Background

  • Evaluation
  • Evaluation capacity building at the local, state and national levels
  • Workforce

Special Projects Coordinator/Internal Evaluation since August 2016

Melissa Quezada
Program Coordinator, Arizona
(520) 626-0721

Flex Support Staff since October 2017

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.