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Florida Department of Health

Top Flex Activities

CAH Quality Improvement

Florida partners with North Highlands, providing one-on-one quality and financial assessments and site visits to all participating critical access hospitals (CAHs). In addition, webinars are held to educate the CAHs on reporting techniques and best practices for quality and financial improvements. CAH conferences are also held to help bring the hospitals together to educate and encourage group collaboration and sharing of best practices. Florida uses the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) financial and the Medicare Beneficiary Quality Improvement Project (MBQIP) measure data reports to provide each CAH with individualized best-fit resources and information to improve upon data outcomes. These tools are great for comparison usage and helping the CAHs to see where improvements can be made. The Florida State Office of Rural Health (The Office) provides ongoing technical assistance as needed to all CAHs through email, phone calls, site visits, and education opportunities.

CAH Operational and Financial Improvement

Florida provides in-depth individual financial and operational assistance and guidance to all the Flex-participating CAHs. Florida has engaged consultants to conduct financial and operational analysis for hospitals affected by Hurricane Michael. The program conducts annual site visits to each CAH in order to assist in operational and financial improvement. The program keeps in close contact with many hospitals to assist with their everyday needs or concerns.

CAH Population Health Improvement

The Office is encouraging hospitals to work with community health partners (e.g., county health departments and rural health networks) to develop and leverage their community health needs assessments (CHNAs) to improve population health. Florida is working with other divisions within the Department of Health and currently collaborating with program managers on diabetes education and prevention, opioid use and substance use disorder (SUD), injury prevention, and the Centers for Disease Control and Prevention (CDC) Heart Healthy Plus program in rural counties.   

Rural Emergency Medical Services (EMS) Improvement

The Florida State Office of Rural Health has partnered with the Bureau of Emergency Medical Oversite to assist and educate rural emergency medical services (EMS) agencies in the areas of population health management and community para-medicine practices. The program also funds a Rural EMS coordinator to focus on improving EMS in rural areas.

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.

Florida Department of Health is working on the Feasible, Actionable, Impactful, and Relevant (FAIR) Rural EMS Project, which aims to improve access to and quality of EMS care in rural areas, and to develop a national model for other states to follow. The goals of the project are to increase the percentage of rural EMS agencies submitting to the National EMS Information System (NEMSIS), develop rural relevant measures submitted to the National Quality Forum (NQF), and creating a national steering committee for the project.

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

The Flex program collaborates with a variety of stakeholder groups including North Highlands, nine Rural Health Networks, the Florida Hospital Association, the Florida Rural Health Association (FRHA), and the Rural EMS Association to help CAHs collaborate with a variety of partners to address the health care needs of their communities. Using State Office of Rural Health (SORH) funds, Florida will fund the FRHA to be a statewide voice for the CAHs, rural health clinics (RHCs), and rural health networks (RHNs). The Office will also collaborate with the Florida Hospital Association, Florida universities, and the Primary Care Office and Association to help CAHs recruit and retain the staff needed for their facilities. Florida also plans to host workshops where CAHs will be encouraged to collaborate, share best practices, and mentor one another.   

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

Flex and SORH staff expect to reach out to peers in Louisiana, Georgia, North Carolina, and Kentucky to inquire about mentoring opportunities and sharing of best practices.

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

A focus of the Flex Program this year is encouraging CAHs to conduct a community health needs assessment (CHNA) with community health partners, including those partners who can help address social determinants of health of their residents. For example, The Office is working with the Bureau of Chronic Disease to leverage their Centers for Disease Control (CDC) Heart Healthy Plus grant. The CDC program is funding positions at seven rural county health departments (CHDs) to implement community health education programs to reduce hypertension, diabetes, and heart disease in their communities. The Office is working with program staff to ensure CAHs and RHCs are participating in these efforts with CHDs and receiving referrals from the education initiative.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1.0
Website Organization Website 
Number of CAHs 12

Flex Program Staff

Lela Shepard
State Office Director, Florida

Specialty areas and background include PMP, grants and contracts, public health preparedness and response, crisis and emergency risk communications, health education and promotion.

Abbie Parmenter
Flex Coordinator, Florida

Flex Coordinator since June 2019

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.