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Louisiana Department of Health

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Program Area: Support for Quality Improvement

The Louisiana Flex Program’s focus on the Quality Improvement program area is to support all Louisiana critical access hospitals (CAHs) to fully participate in the Medicare Beneficiary Quality Improvement Project (MBQIP). Currently, 25 out of the 27 Louisiana CAHs have committed to participation in MBQIP. Twenty-four are currently reporting on one or more MBQIP measures and one additional CAH will begin reporting on MBQIP measure sets this year. 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 Rural Health Solutions. In the past year, reporting rates improved in each MBQIP domain:

  • reporting on immunization measures (patient safety) improved from 13 to 16 hospitals;
  • reporting on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results improved from 19 to 20 hospitals;
  • reporting on outpatient measures improved from 16 to 17 hospitals;
  • and reporting on Emergency Department Transfer Communication (EDTC) measures improved from 21 to 24 hospitals.

Program Area: Support for Financial and Operational Improvement

Financial indicators for Louisiana CAHs are higher on average than for CAHs nationally. One weakness was that the hospitals had 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 was 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 year activities will focus on studying opportunities for Louisiana CAHs to improve revenue flow.

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

A training workshop was provided in June 2018 to provide an overview of 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 Medicare Beneficiary Quality Improvement Project (MBQIP) support, provided by the Rural Quality Improvement Technical Assistance (RQITA) team, 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.

After a failed attempt at providing a remote data extract service through the Small Rural Hospital Improvement Program (SHIP) program activities, the Louisiana Flex Program was able to initiate a new effort for supporting hospitals to collect data more accurately and efficiently. A software program (HORSE) is being made available to the hospitals that will work with their billing programs to randomly select charts and perform the bulk of data abstraction for outpatient and inpatient measures.

Program Statistics

Type of Organization State Government
Staffing 2.5 FTEs
Number of CAHs 27
Website URL Organization Website

Flex Program Staff

Tracie Ingram
SORH Director, Louisiana
225-342-1889

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) 342-1525

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.