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Arkansas Department of Health

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Program Area: Support for Quality Improvement

The Arkansas Flex Program will contract with a vendor for assistance with reporting and quality improvement activities for the Medicare Beneficiary Quality Improvement Project (MBQIP) HCP/OP-27 quality measure and IMM-2 quality measure by providing education, resources, and training to critical access hospitals (CAHs) to implement influenza vaccination. This will include status assessments on all patients that allow identification, successful administration, and documentation of vaccinations in eligible patient populations. Education and training will be provided on how to engage physicians and staff to effectively promote influenza vaccinations to their patients through evidence-based literature and education. The Arkansas Flex Program will assist CAHs in identifying and implementing processes for successful tracking and evaluation of performance. This will build processes and policies for health care providers to improve patient safety by ensuring all employees receive influenza vaccinations, or an alternative method of protection if an employee has an allergy or other allowable reason for not accepting the influenza vaccination. The Arkansas Flex Program will work with CAHs to engage in their communities to promote involvement in community vaccination programs in their patient population areas, including providing resources and education through email, webinars, video conferencing, and onsite visits.

The Arkansas Flex Program will contract with a vendor for assistance with reporting of quality improvement activities for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys by providing education on analysis of HCAHPS data, gap analysis to focus on areas with greatest performance improvement needs, employee education, proper tracking, and timely evaluation of performance and follow-up. The vendor will provide opportunities for collaboration with other CAHs in the state through workshops and regional meetings to promote sharing of best practices, 1:1 education and support for lowest performers through emails, video conferencing, and onsite visits. The target goal for reporting is all 29 CAHs. 

The Arkansas Flex Program will contract with a vendor for assistance with reporting and quality improvement activities for MBQIP emergency department transfer communication measures (EDTC). The vendor will provide education and training through emails, video conferencing, and onsite visits to identify target areas and interventions that improve outcomes for patients transferred from the CAH health care setting. The vendor will focus work on those CAHs that are not consistent with reporting and CAHs that are low performers. 

The vendor will continue education, training, and processes for CAHs identified as low performers for reporting EDTC measures. They will also provide education and training through video conferencing and onsite visits to CAHs who have experienced a significant decrease in an EDTC measure. 

The Arkansas Flex Program will contract with a vendor for assistance with reporting and quality improvement activities regarding MBQIP outpatient measures (OP-1, OP- 2, OP-3, OP-5, OP-20, OP-21, and OP-22) to improve patient care and outcomes in CAH outpatient settings. The vendor will provide education and training through emails, video conferencing, and onsite visits to identify target areas and interventions that improve patient care and patient outcomes in the outpatient setting. The vendor will focus work on those CAHs that are not consistent with reporting and CAHs that are identified as low performers. The target goal for reporting is all 29 CAHs. 

Program Area: Support for Financial and Operational Improvement

The Arkansas Flex Program will continue the contract with Wipfli to provide a limited number of Emergency Department (ED) reviews. A Notice of Funds Availability will be developed in accordance with the Arkansas Department of Health policies on procurement laws. Hospital administrators must agree in writing to provide all requested documentation and personnel support requested by the contracted vendor to perform the ED reviews. Hospitals will be selected on a first-come-first-served basis. 

The contracted vendor will perform a review of the selected CAH’s ED, including an understanding of average volumes, peak volumes, processes, and market share opportunities to expand services in the local market area.

Wipfli will perform a detailed review of the Medicare cost report, including all costs, revenue, statistics, and groupings to evaluate proper reporting on the Medicare cost report. The contracted vendor will review the hospital’s organizational structure to determine if changes to the corporate structure could enhance Medicare reimbursement. 

Wipfli will review 30 medical records across CAH service lines ED level of service guidelines; revenue and usage report by code; coding and documentation tools and guidelines; a current listing of providers the CAH bills fo;, their credentials and specialties; current professional services evaluation and management (E/M) fee schedule; internal coding audits; and expected payor’s contractual reimbursement amounts and insurance contracts. 

Wipfli will identify and review selected medical records across CAH service lines. The following three services:

  • mid-cycle revenue cycle review
  • in-depth Medicare cost report review;
  • and a Rural Health Clinic operational review

will be available to those CAHs who operate a provider-based Rural Health Clinic to improve their organization's financial operations. 

Program Area: Support for Integration of Innovative Health Care Models 

Faith-Based Coordination Initiative – The Arkansas Flex Program will be collaborating with the Arkansas Department of Health Faith-Based Department to address the re-admission issues with the Arkansas CAHs. The Flex Program and Faith-Based Program will work with various religious institutions and the CAHs to identify and train lay persons who will be able to improve the health of individuals and their communities. Health professionals and spiritual leaders will be able to improve the health of their rural communities by partnering to use faith-based entry points into rural communities to decrease the health disparity gaps.

When comparing the numbers of individuals who attained proper primary health care screenings, both rural men and women received appropriate services at a much lower rate than their urban counterparts. Rural Americans also tended to receive primary care services at lower rates than their urban counterparts. Addressing the barriers to achieving improved access and utilization of primary care services within this group is one crucial step in lowering the mortality of rural America. In addition, while rural communities are generally disproportionately affected by health outcomes than their urban counterparts, in a similar manner, there are health disparities between rural white residents and rural non-white residents. While these disparities have strong geographic differences with unique perspectives, there is hope that a faith-approach is an effective way to promote wellness, especially within black rural communities.

The lack of access to care in rural communities is multifaceted. While 18% of Americans live in rural areas, yet only about 9% of the nation’s health care providers practice there. Urban areas boast a ratio of 53.9 physicians per 100,000 people, while rural areas have 39.8 physicians per 100,000. In addition, many health care providers are located in rural communities that are too deurbanized to be able to efficiently serve all parts of their service area all the time. As previously mentioned, there are many more religious institutions than clinics in small towns. These religious institutions could provide a base of operations for health care providers allowing them to extend their reach into the most remote communities. Additionally, religious institutions tend to have a cadre of volunteers who could help extend scarce rural health care resources. 

The focus of the program will be to link a layperson within each community with an individual(s) who has had a history of re-admission in the CAH. The layperson would be trained in providing services such as transportation, medical visits (behavioral health visits, vision, dental), medical follow-up appointments, assisting patients with medications, and with insurance (Medicare, Medicaid or private). 

The Faith-Based Initiative will work with all 29 CAHs annually.

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

The Arkansas Flex Program is currently working with the Arkansas Foundation for Medical Care who works with the 29 CAHs on quality improvement. The Arkansas Flex Program is also working with Wipfli who provides financial and operational assistance to all of the CAHs. The Flex Program continues to partner with the Clinton School of Public Service which provides evaluations and assessments on the CAHs.

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

The Arkansas Flex Program is currently utilizing the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) to educate CAHs on their data.

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

No

Program Statistics

Type of Organization State Government
Staffing 1.0 FTE
Number of CAHs 29
Website URL Organization Website
 

Flex Program Staff

Sherry Johnson
State Office Director, Arkansas
(501) 280-4563

State Office of Rural Health Director since May 2018

Harold Clayton
Flex Coordinator, Arkansas
(501) 614-5377

Flex Coordinator since March 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, $1,100,000 (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.