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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  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. The program conducts annual site visits to each CAH in order to assist in operational and financial improvement. The program is engaging with their contractor to conduct cost report analyses for each of Florida’s 10 CAHs and collaborate with seven Florida CAHs to implement a strategic pricing program. Both activities are aimed to help CAHs better navigate their finances during COVID. Florida was also able to distribute information about COVID-19 funding and resources at the beginning of the pandemic to help guide hospitals through the tumultuous time. They keep in close contact with many hospitals to assist with their everyday needs or concerns. Florida recently used Flex carryover funds to purchase telemedicine platforms for CAHs and rural EMS agencies to improve the diagnosis and treatment of COVID-19 patients in rural areas. They expect these telemedicine platforms to be in place by June 30, 2021. In 2021-22, they will support CAHs as they leverage and expand the tool beyond its use in the emergency department and to primary care telemedicine needs. 

CAH Population Health Improvement

Florida 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 paramedicine practices. The program funded a rural EMS leadership series to help educate leadership on topics such as quality improvement, finance, workforce development, and other topics. The program also funds a Rural EMS coordinator to focus on improving EMS in rural areas and expanding community paramedicine in rural counties. The EMS coordinator holds quarterly regional EMS workgroup calls to help provide technical assistance to rural EMS agencies and provide them with additional resources and networking opportunities.

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.

Florida collaborates with a variety of stakeholder groups including nine Rural Health Networks (RHNs), the Florida Hospital Association, the Florida Rural Health Association (FRHA), Local Health Planning Councils, 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 is supporting the Florida Rural Health Association’s Project ECHO hub through the funding of teleclinics on rural community paramedicine and COVID-19 topics. The Flex Program is increasing the capacity of FRHA to be a statewide voice for Florida’s rural health clinics (RHCs).

SORH funds are also being used to increase collaboration and information sharing among RHNs and other stakeholders to address the population health needs and challenges of Florida rural residents due to the COVID-19 pandemic. They also collaborate with the Florida Hospital Association, Florida Agency for Health Care Administration (AHCA), Florida Area Health Education Centers (AHECs), Florida Volunteer Health Services, Florida universities, and the Office of Primary Care 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. Last year, the Flex program partnered with other states to collaborate on their respective conferences and held a joint networking lunch for all hospitals.

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. The Flex Program is also focused on providing more one-on-one direct technical assistance to CAHs based on annual site visits and assessments. Florida recently received approval to hire additional Flex staff for this need. For example, they are 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. They are 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?:
No
Type of Organization State Government
Staffing (FTE) 1.0
Website Organization Website 
Number of CAHs 10

Flex Program Staff

Lela Shepard
State Office Director, Florida
(850) 617-1458

Specialty Areas / Background

Grants and contracts, public health preparedness and response, crisis and emergency risk communications, health education and promotion.

State Office Director since April 2019

Abbie Parmenter
Flex Coordinator, Florida
(850) 558-9665

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.