Louisiana State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

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:  

  • Reporting on immunization measures (patient safety) improved from 8 to 11 hospitals
  • Reporting on HCAHPS results improved from 8 to 15 hospitals
  • Reporting on Outpatient measures improved from 6 to 13 hospitals
  • Reporting on EDTC measures improved from 1 to 14 hospitals
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: 

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

Program Area: Support for Financial and Operational Improvement: 

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.

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 planned 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 (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

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.

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

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.

Program Statistics

What type of organization is your Flex office housed in?: 
State Government
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

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.