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Idaho Bureau of Rural Health & Primary Care

Top Flex Activities

CAH Quality Improvement

The Idaho Flex Program is implementing “Moving Beyond the Measures,” Medicare Beneficiary Quality Improvement Project (MBQIP) learning collaborative webinars for critical access hospital (CAH) Quality Improvement (QI) Directors to receive evidence-based tools and strategies to improve MBQIP measures. These opportunities focus on providing CAHs with MBQIP benchmarking of all required measures, data collection best practices, and sharing evidence-based tools and strategies to improve outcomes.

Activities include: (1) four learning collaborative webinars annually focused on a specific quality improvement project facilitated by Cynosure Health ; (2) individual technical assistance provided by Cynosure Health via telephone or webinar to each CAH to review all hospital-specific MBQIP data and provide tools and strategies to improve; (3) virtual technical assistance site visits conducted annually to 27/27 (100%) CAHs by the Flex Coordinator; (4) implement three competitive CAH subawards for an in-depth quality department assessment and create a targeted action plan to improve all MBQIP measures below the state benchmark, where CAHs can select their consultant of choice; (5) provide an educational webinar and technical assistance from Allevant on how to improve swing bed programs, where topics include data collection best practices and sharing evidence-based tools and strategies to improve outcomes; (6) provide access to the University of Washington Tele-Antimicrobial Stewardship Program: weekly ECHO clinics and access to all materials on their website to improve antibiotic stewardship and reduction in Healthcare-Associated Infections (HAIs).

CAH Operational and Financial Improvement

Eide Bailly will conduct a Financial Learning Collaborative webinar for CAH Chief Executive Officers (CEOs) and Chief Financial Officers (CFOs) to provide a forum for sharing ideas and strategies to improve financial indicators. Eide Bailly will also lead an Idaho CAH Financial Summit for CAH CEOs and CFOs to provide evidence-based tools and strategies to improve financial measures. This opportunity allows for discussions to address challenges and share strategies. Eide Bailly will provide a Revenue Cycle A-Z five-session virtual series to Idaho CAH staff. Topics to be covered include Key Performance Indicators (KPIs), inpatient services, outpatient services, swing beds, Rural Health Clinics (RHCs), coding, modifiers, and much more. Eide Bailly also conducts individual CAH consultations via telephone to review hospital-specific financial data and provide practical tools and strategies for improvement.

Continued collaboration with the Idaho Hospital Association (IHA) to collect real-time financial data for all CAHs statewide: Financial Indicator Project (FIP). Idaho CAHs report and compare their financial data using Flex Monitoring Team (FMT) reports and real-time data to enable peer comparisons. The Flex Coordinator can log in and access data as it is submitted quarterly and is working with IHA to create meaningful, hospital-specific reports for the CAH CEOs and CFOs. CAHs use FMT cost report data for trending and access the most-current financial data from FIP to facilitate benchmarking. CAHs reporting real-time data to FIP are eligible to compete for scholarships to support conference attendance and receive information on financial best practices and policy updates. In addition, these eligible hospitals are also able to compete for six competitive CAH subaward to select a consultant of choice to initiate a revenue cycle analysis or a chargemaster review.

The Flex Coordinator engages one CAH in need per year to support an in-depth financial/operational assessment. The assessment includes an analysis of the 10 indicators in the CAH Finance 101 Manual and will enable the creation of an in-depth action plan to address issues in the targeted facilities.

The Flex Coordinator implements virtual technical assistance site visits with all 27 CAHs to meet with the CEO/CFO and discuss FMT data and trends, as well as the IHA initiative (FIP). These visits enable the Flex Coordinator to better assess their needs and ensure a comprehensive understanding of the data. The Flex Coordinator provides information and/or best practices to the CAHs as needed. The Flex Coordinator has 13/27 (48%) of CAHs who agree to be transparent with their financial data to support sharing and in-depth conversations amongst peer CAHs and continues to encourage transparency with this initiative.

The Flex Coordinator will engage with Cynosure Health to develop value-based care transformation plans for Idaho CAHs. This plan will outline innovative strategies for CAHs to adopt to navigate value-based payment models.

CAH Population Health Improvement

Rural Health Innovations (RHI) will provide educational webinars on strategies and best practices to implement population health initiatives. RHI will also help develop CAH-specific action plans to improve population health in their communities and conduct technical assistance to assist in implementation.

Rural Emergency Medical Services (EMS) Improvement

The Flex Coordinator will engage with Syringa General Hospital to implement an Emergency Medical Technician (EMT) Community Health EMS (CHEMS) course for rural EMTs serving CAH areas.

The Flex Coordinator will release a competitive opportunity to engage two rural EMS agencies serving CAHs to implement Community Health EMS projects.

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.

The Idaho Flex Program's project is to conduct a Rural Trauma Team Development Course for CAHs and rural emergency medical services (EMS) agencies serving CAH areas.

To support Community Health EMS (CHEMS), the Idaho Flex Program will provide a competitive subaward to rural EMS agencies to implement a CHEMS pilot project. In addition, the Flex Program will conduct a Certified Emergency Medical Technician (EMT) CHEMS online course to support further education in rural Idaho for EMS agencies serving CAHs.

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

The Flex Program Coordinator participates in the planning committee for the Western Region Flex Conference. Idaho also participates in the Northwest Rural Health Conference along with the Washington and Oregon Flex programs. In addition, the Idaho Flex Program is working with the Arizona, Oregon, Utah, and Washington Flex Programs to implement the University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) weekly ECHO sessions to provide support for antibiotic stewardship.

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

The Flex Program Coordinator is participating in the planning committee for the Western Region Flex Conference. In addition, the Idaho Flex Program is working with the Oregon and Washington Flex Programs to implement the University of Washington Tele-Antimicrobial Stewardship Program (UW TASP) weekly ECHO sessions to provide support for antibiotic stewardship.

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

The Idaho Flex Program partners with the State Office of Rural Health grant program to coordinate efforts with Eide Bailly to work on financial and operational improvement initiatives with CAHs and provider-based Rural Health Clinics (RHCs) to benchmark and improve financial/operational data. This collaboration is also an effort to support CAHs and RHCs as they work towards value-based care.

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 27

Flex Program Staff

Mary Sheridan
State Office Director, Idaho
(208) 332-7212

Specialty Areas / Background

Mary is a registered nurse. Her specialty areas include rural emergency medical services, nursing, health care quality, and patient safety.

State Office Director since October 2003 

Stephanie Sayegh
Flex Coordinator, Idaho
(208) 332-7363

Specialty Areas / Background

Stephanie has a M.A. in International Affairs with a focus on socio-economic development. She has supported a variety of health programs in Honduras, Sierra Leone, and Mozambique.

Flex Coordinator since November 2013

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.