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Louisiana Department of Health, Bureau of Primary Care & Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The Louisiana Flex Program’s focus in the quality improvement (QI) program area is to support all Louisiana critical access hospitals (CAHs) to fully participate in the Medicare Beneficiary Quality Improvement Project (MBQIP). Louisiana Flex has taken several different approaches in recent years to increase the number of CAHs that fully participate in MBQIP. Currently, 25 out of the 27 Louisiana CAHs are reporting on one or more MBQIP measure set. Past activities include meeting directly with hospital Chief Executive Officers (CEOs) to explain the MBQIP program and benefits, and implementing peer-to-peer training sessions for hospitals presented by QI team members and two hospitals already participating in MBQIP.

In fiscal year (FY) 2016, activities began shifting to support CAHs to more fully participate in MBQIP and how to use the data reports to assist their hospital to make changes, identify opportunities for cost savings, expansion of services, etc. through a combination of training webinars and 1:1 hospital team meetings provided by a subcontractor, Rural Health Solutions. In the past year, reporting rates improved in each MBQIP domain:

  • Reporting on Immunization measures (patient safety) improved from 11 to 13 hospitals
  • Reporting on Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) results improved from 15 to 19 hospitals
  • Reporting on Outpatient measures improved from 13 to 16 hospitals
  • Reporting on Emergency Department Transfer Communication (EDTC) measures improved from 14 to 21 hospitals

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

Louisiana CAHs requested hands-on, step-by-step training on reporting data into electronic systems. Although Louisiana Flex could find many training resources on utilizing data, the specific training requested by the hospitals could not be found. Two 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 Louisiana Flex Program website for hospitals to access as needed here.

Program Area: Support for Financial and Operational Improvement

Financial indicators for Louisiana CAHs are higher on average than for CAHs nationally. The one area where the Louisiana Flex Program noticed a weakness was that our hospitals had a higher debt load than the national average. In FY 2015, an assessment was conducted to determine reasons for the higher debt load and strategies for improvement. Results of the assessment indicated that the debt rates 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 identified with higher than average debt levels. Results from the new assessment indicated that the hospitals no longer had a high debt ratio (or possibly that initial information was incomplete in the first assessment). Current fiscal year activities will focus on studying opportunities for Louisiana CAHs to improve revenue flow.

In FY 2017, Louisiana Flex is contracting with the Association of Rural Health Professionals (ARHPC) 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.

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

A web training series is in development that will include several topics related to value-based incentive programs.

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

Louisiana CAHs do not have a formal network. Web-based quarterly meetings as part of the MBQIP support provided by Rural Health Solutions provide an informal opportunity for hospitals to share ideas and request assistance on similar challenges.

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

In coordination with the Louisiana Small Rural Hospital Improvement Grant Program (SHIP), Louisiana Flex has been able to enhance the capability of reporting on outpatient measures. The Louisiana SHIP Program provides for a vendor to remotely extract outpatient data and report into QualityNet. The vendor participates in MBQIP calls with CAHs to provide additional insight on these measures and recommendations for improvements.

Program Statistics

Type of Organization State Government
Number of CAHs 27
Website URL Organization Website

Flex Program Staff

Tracie Ingram
SORH Director, Louisiana

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 Smith
Flex Coordinator, Louisiana
(225) 342-3506

Specialty Areas/Background

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

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.