Kentucky State Flex Profile

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. Kentucky will provide best practice guidelines in areas identified in the "deep dive" and train hospitals on the utilization of Patient Safety Organization (PSO) 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 will be measured by the number of hospitals participating in KIPSQ, attending KIPSQ webinars and submitting data in the "deep dive." The Flex Program will survey hospitals to determine implementation of education and best practice guidelines distributed by the PSO.

In the effort of stroke care improvement, Kentucky will use a developed Stroke Care Improvement program in partnership with the American Heart and Stroke Association for small rural hospitals and critical access hospitals (CAHs) to provide a comprehensive training program and best practices guide through a certified primary stroke center. Three stroke care improvement workshops will be held in the state, with three hospitals attending the first and two attending the second. All sessions will have post-training assessments.

This year, the Kentucky Flex Progam is implementing a new quality improvement (QI) director training. This training will cover the basics of what a new 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. 

Please share a success story about reporting quality data or using quality data to help Critical Access Hospitals (CAHs) in your state improve patient care: 

Kentucky is averaging about 80% of CAHs reporting their emergency department transfer communication (EDTC) data. For Kentucky, this is hugely successful. Hospitals are reading and using these reports and asking questions relevant to them.

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 onsite analysis and technical assistance. KHREF and KHA review all 29 of the Kentucky CAHFIRs and use them to identify CAHs needing assistance and/or onsite 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 onsite visits to small rural hospitals to:

  • Consult with administrators and key staff
  • Identify and prioritize individual hospital need
  • 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 done 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 trainings and/or projects at an in depth level for a select few hospitals who apply for this assistance.

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

Community paramedicine will likely develop further this year in Kentucky and is a focus under the population health management program area. The state will also be looking to provide board training and continue support of rural health networks across the state.

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

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

Please provide information about network activities in your state to support Flex Program activities (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

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.

From the last Flex Program year, please describe a best practice you would like to share with other states: 

Get out there, be seen, be heard, be supportive, be helpful.

Program Statistics

What type of organization is your Flex office housed in?: 
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

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

Kevin Fleming
Rural Project Manager, Kentucky

Specialty Areas/Background

  • Over 20 years of health care experience
  • Background in community-based rehabilitative and habilitative services for people with disabilities
  • Previously with Kentucky Protection & Advocacy

Rural Project Manager since February 2017

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

Rural Project Manager since February 2014

Johnnie Lovins
Rural Project Manager, Kentucky

Rural Project Manager since September 2017

Jennifer Wilson
Rural Health Manager, Kentucky

Rural Health Manager since March 2016

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.