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Arkansas Department of Health

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CAH Quality Improvement

The Arkansas Foundation for Medical Care (AFMC) will identify quality improvement issues, and provide technical assistance to Arkansas’ 28 critical access hospitals (CAHs) as determined by hospital performance with the Medicare Beneficiary Quality Improvement Project (MBQIP) measures data reports.  These data reports consist of Patient Safety/Inpatient/Outpatient, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and Emergency Department Transfer Communication (EDTC) measures. The MBQIP project is for CAHs to implement quality improvement initiatives to improve their patient care and operations.

AFMC will conduct regional collaborative area learning sessions in three or four regions in the stat, once per year. These sessions facilitate learning in small groups and provide a forum for education on new, innovative strategies for improving quality improvement scores and sharing best practices.

AFMC will provide quarterly reports to the Flex Coordinator. These written reports will include the number of CAHs contacts, a list of CAHs that are performing poorly with their measures, methods to improve poor performing CAHs, and results of those measures. Technical assistance will also be provided to CAHs via physical on-site, virtual WebEx, e-mails, video conference, or telephone.

Activites Measured:

The Arkansas Flex Coordinator will maintain ongoing communication with AFMC to provide programmatic guidance and review reimbursement requests. The Flex Coordinator will participate in site visits, webinars, and conference calls with AFMC to ensure the contractor is implementing contracted deliverables with all 28 CAHs as it relates to quality improvement.

CAH Operational and Financial Improvement

Wipfli LLP will provide mid-cycle revenue cycle on-site reviews of hospitals, outpatient, and clinic cases to identify coding and billing errors, as well as potential charge capture and pricing issues.  They will also provide rural health clinic (RHC) operational on-site assessments. Wipfli will review the hospital Medicare cost report for opportunities related to clinic operations, and they will prepare benchmark comparisons using Medical Group Management Association surveys, provider-based RHC cost reports, and other relevant internal and external resources.

Wipfli LLP will provide mid-cycle denial assessment on-site reviews of hospitals' denial management activities to ensure that it has implemented processes that support a denial rate that correlates with its payer mix for the health care organization, as well as provide one high-level Medicare reimbursement on-site review of “high risk” and “mid risk” CAH Medicare cost report, including all costs, revenue, statistics, and groupings to evaluate proper reporting on the Medicare cost report.

Technical assistance will also be provided to CAHs and their provider-based RHCs via physical on-site visits, e-mails, video conference, and telephone.

Activities Measured:

The Arkansas Flex Coordinator will maintain ongoing communication with Wipfli LLP to provide programmatic guidance. The Flex Coordinator will participate in on-site visits, and conference calls with Wipfli LLP to ensure the contractor is implementing contracted deliverables with CAHs and their provider-based rural health clinics that are labeled "High Risk" and "Mid Risk" for closure from a financial perspective.

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

The Arkansas Office of Rural Health & Primary Care Medicare Flex Program is working closely with the Arkansas Hospital Association to provide more extensive quality improvement and financial assistance to the CAHs.

The Arkansas Medicare Flex Program is working closely with the New York Institute of Medicine, College of Osteopathic Medicine in the area of rural recruitment and retention.

The Flex Program is beginning to work together with the University of Arkansas for Medical Sciences (UAMS) for sharing information with CAHs regarding telehealth.

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

The Arkansas Flex Program is currently reaching out to the University of Arkansas at Little Rock with the initial stages of a needs assessment.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1
Website Organization Website
Number of CAHs 28

Flex Program Staff

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, $1,009,121 (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.