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Kentucky Office of Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

In the Patient Safety Organization within The Kentucky Institute for Patient Safety and Quality (KIPSQ) project, hospitals receive an electronic patient safety event reporting system and participate in one "deep dive" for small rural hospital quality improvement unintended events. The Kentucky Flex Program provides best practice guidelines in areas identified in the "deep dive" and trains hospitals on the utilization of Patient Safety Organizations (PSOs) for peer review activities, as well as review patient safety and patient error data using the Agency for Healthcare Research and Quality (AHRQ) common formats. This is measured by the number of hospitals participating in KIPSQ, attending KIPSQ webinars and submitting data in the "deep dive." The Kentucky Flex Program plans to survey hospitals to determine implementation of education and best practice guidelines distributed by the PSO.

The Kentucky Flex Program continues to provide quality improvement (QI) director training. This training covers the basics of what a new critical access hospital (CAH) QI director needs to know regarding the Medicare Beneficiary Quality Improvement Project (MBQIP), the Kentucky Hospital Engagement Network (KHEN), and other quality initiatives. Most importantly, Kentucky is focusing on improvement around MBQIP measures with training specific to each subset of measures. 

The Kentucky Flex Program continues to also provide Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) training, stroke education, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training, and MBQIP improvement activities.

Program Area: Support for Financial and Operational Improvement

Kentucky uses the Flex Monitoring Team (FMT) CAH Financial Indicators Report (CAHFIR) to identify CAHs that have poor financial performance in a number of indicators within the last three years. The Kentucky Hospital Research and Education Foundation (KHREF) and Kentucky Hospital Association (KHA) staff work with a nationally recognized accounting firm specializing in rural issues or with another nationally recognized consultant to provide on-site analysis and technical assistance (TA). KHREF and KHA review all 29 of the Kentucky CAHFIRs and use them to identify CAHs needing assistance and/or on-site technical assistance.

A large effort in this program area is continuing to offer chargemaster reviews and revenue cycle management training for a select number of CAHs.

The Kentucky Flex Program continues to schedule and facilitate on-site visits to small rural hospitals to:

  • Consult with administrators and key staff
  • Identify and prioritize individual hospital needs
  • Share rural relevant information and updates on state and national agendas
  • Rank all visited hospital needs in order of significance to determine the most appropriate utilization of grant funds, select topics/speakers for regional meetings, and share with all administrators and partners to create an arena for networking and strategic planning

Site visits are conducted every year to develop a feel for where hospitals are at and where they may have questions or need assistance. Kentucky will continue to offer Lean training and/or projects at an in-depth level for a select few hospitals who apply for this assistance.

The Kentucky Flex Program continues to provide chargemaster reviews, revenue cycle management training, swing bed training, a CAH finance 101 training, in-depth Lean training for up to two hospitals per year, board training, and scholarships to leadership conferences. 

The Kentucky Flex Program is also doing board assessments, Practice Operations National Database (POND) access and support, hosting a rural health clinic (RHC) summit, a Telehealth Summit, and working with RHCs on network activities. RHCs will also be offered a coding boot camp and the chance to get RHC Professional Certification. 

Program Area: Support for Population Health Management and Emergency Medical Services Integration 

The Kentucky Flex Program is currently working with the Kentucky Board of Emergency Medical Services (EMS) on community paramedicine efforts and in the planning of the 2019 EMS Leaders in Kentucky Summit. 

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care.

Education is ongoing for CAHs regarding the transition to value-based care. Kentucky CAHs receive education and TA through training, conferences, and network meetings.

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

Kentucky works with several rural health networks across the state in a variety of capacities. Please contact Kayla Combs for more information. The state works with a variety of horizontal and vertical networks.

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

The Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) has really been an invaluable tool that the Kentucky Flex Program uses to not only write grants and share the information with hospitals but also for Performance Improvement & Measurement System (PIMS) reporting.

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


Program Statistics

Type of Organization University
Staffing 2.5 FTEs
Number of CAHs 29
Website URL Organization Website

Flex Program Staff

Ernie Scott
State Office Director, Kentucky
(606) 439-3557

Specialty Areas / Background

  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)
  • Electronic health records
  • Grants/project management, contractual agreements
  • Critical access (CAHs) and small rural hospitals
  • Rural health policy
  • Stakeholder relations
  • Contractual agreements
  • Strategic planning
  • Quality improvement
  • Registered Radiologic Technologist

State Office Director since November 2013

Kayla Combs
Flex Coordinator, Kentucky
(606) 439-3557

Specialty Areas / Background

  • Degree in Health Administration
  • Previous experience as an intern working with Lean

Flex Coordinator since January 2013

Mike McGill
Rural Project Manager, Kentucky

Rural Project Manager since May 2018

Marcus Pigman
Rural Project Manager, Kentucky
(606) 439-3557, ext. 83583

Rural Project Manager since February 2014

Alice Combs
Administrative Support Associate I, Kentucky
(606) 439-3557

Specialty Areas / Background

Administrative office management

Staff Support Associate I since January 2008 

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.