Louisiana State Flex Profile
Top Flex Activities
The Louisiana Flex Program’s focus in the Quality Improvement program area is to support all Louisiana critical access hospitals (CAHs) to fully participate in Medicare Beneficiary Quality Improvement Project (MBQIP). Louisiana has taken several different approaches in previous years to increase the number of CAHs that have signed the memorandum of understanding to 26 out of the 27 Louisiana CAHs. These activities included meeting directly with hospital CEOs to explain the MBQIP program and benefits as well as implementing peer-to-peer training sessions for hospitals presented by quality improvement (QI) team members at two hospitals already participating in MBQIP.
In FY 2016, activities began shifting to more fully support CAHs participating in MBQIP. Activities included how to use data reports to make changes, identify opportunities for cost savings, expansion of services, etc. and were delivered through a combination of training webinars and 1:1 hospital team meetings provided by a subcontractor. Reporting rates have improved in each MBQIP domain:
Louisiana CAHs requested hands-on, step-by-step training on reporting data into electronic systems. Although the Louisiana Flex Program could find many training resources on utilizing data, the state Flex staff could not locate the specific training requested by the hospitals. Two of Louisiana's CAHs that had already been successful in data reporting agreed to design a training toolkit and provide peer-to-peer instruction classes to the other CAHs. The training toolkits are available on the state Flex Program's website for hospitals to access as needed: Louisiana MBQIP Peer Training Toolkit
Financial indicators for Louisiana CAHs are better on average than CAHs nationally. However, one area where the state noticed a weakness was that Louisiana hospitals have a higher debt load than the national average. An assessment was conducted in FY 2015 to determine reasons for the higher debt load and strategies for improvement. Results of the assessment indicated that the debt rate of three hospitals were higher than average but otherwise Louisiana CAHs do not carry large debt loads.
The financial assessment for FY 2016 focused specifically on the three hospitals previously identified as having higher than average debt levels. In FY 2016, the Louisiana Flex Program subcontracted to provide financial assessment audits for Louisiana CAHs focused on the usage of CPT, HCPCS II and ICD-10-CM codes to evaluate the accuracy of coding practices and identify potential lost revenue or compliance risk. Information is received via a secure ShareFile. Ten Evaluation and Management (E&M) encounters (“audits”) are conducted for two providers at each CAH.
A web training series is planned that will include several topics related to value-based incentive programs.
Louisiana CAHs do not have a formal network. Web-based quarterly meetings, as part of the MBQIP support provided by a subcontractor, provide an informal opportunity for hospitals to share ideas and request assistance on similar challenges.
During FY 2016, the Louisiana Flex Program has continued several approaches that worked well in FY 2015. Site visits have shifted into less formal meetings that are being used as an opportunity to answer questions about MBQIP (as well as other Flex and SHIP activities but MBQIP is the big topic they all want to talk about). The state Flex team is learning more about the hospitals and they express appreciation for the practical assistance gained through the visits.
Flex Program Staff
Specialty Areas / Background
Tracie Ingram is the Rural Health Officer and Health Systems Development Manager for the Bureau of Primary Care and Rural Health. She has over 25 years of service in state government. Her experience includes:
- Rural health clinic (RHC) and federally qualified health center (FQHC) development
- Grants coordination and management
- Local, state, and federal grant submission review
SORH Director since January 2009
Kandi is responsible for assisting the State Office of Rural Health (SORH) Director in the coordination of the State Medicare Rural Hospital Flexibility Program for Louisiana and ascertaining all program policies and guidelines and ensuring program operations conform to the goals of the department and meet federal and state laws and regulations.
Flex Coordinator since April 2010