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Nevada State Office of Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The focus of the Nevada Flex Program includes implementing proven and innovative technical assistance (TA) for Medicare Beneficiary Quality Improvement Project (MBQIP) quality reporting and improvement. Every quarter, members from 13 of the state’s critical access hospitals (CAHs) are invited to the Nevada Rural Quality Improvement Network, Risk Manager Work Group, and Infection Control Work Group meetings to learn, share their experiences, and provide peer support on quality improvement and patient safety. Individual TA is provided to each CAH as needed.

Program Area: Support for Financial and Operational Improvement

The Nevada Flex Program and its principal program collaborator, Nevada Rural Hospital Partners (NRHP), are implementing a wide range of TA to support rural hospital financial, operational, and performance improvement. The Nevada Flex Program also supports facilitation of a statewide rural hospital Performance Improvement Network among Nevada’s 13 CAHs and participation in revenue cycle management activities.

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

For the past two decades, the Nevada Flex Program has supported a variety of TA to further rural population health management and emergency medical services (EMS) integration, including the production and dissemination of eight editions of the Nevada Rural and Frontier Health Data Book and four editions of the Health Care Careers in Nevada guide for rural middle school and high school students.

Please provide information about Collaboration/Shared Services 

The Nevada Flex Program is currently working with rural stakeholders and rural policymakers to facilitate the establishment of rural local boards of health and the development of public health services in rural and frontier regions of Nevada.

Program Area: Support for Integration of Innovative Health Care Models 

The Nevada Flex Program continues to support CAH participation in Project ECHO Nevada. Project ECHO Nevada connects university-based faculty and specialists in Reno to primary care providers in rural and other underserved areas across the state. Project ECHO Nevada reduces rural primary health care providers’ professional isolation and provides training to enhance the clinical capacity by increasing their knowledge of best practices. The goal is to improve patient access to specialty health care in rural and medically underserved areas in Nevada. As well as improve retention of health care spending in rural communities, increase patient and provider satisfaction, and improve rural primary health care provider retention.

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

For nearly two decades, Flex funding has been utilized to augment and extend Nevada Rural Hospital Partners (NRHP) and the network-oriented TA provided by NRHP, including rural recruitment and retention, wellness coordination and programming, and telehealth/information technology technical support. 

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

For over a decade, the Nevada Flex Program continues to support the CAHs that meet quarterly to develop and implement network-based strategies to facilitate the transition to value-based care and improved population health management:

  • Quality Improvement Network (QIN) for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), inpatient and outpatient and emergency department transfer communication (EDTC) measures.
  • Infection Control Work Group to facilitate the development and implementation of antibiotic stewardship programs and capacity in all CAHs. Currently, 12 of 13 Nevada CAHs are enrolled in the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).

Please provide information about cross-state collaborations you may be working on related to the Flex Program.

For the past 16 years, the Nevada Flex Program has collaborated with colleagues in Arizona, California, Hawaii, New Mexico, Utah, and other western states to support CAH Chief Executive Officer (CEO) and Chief Financial Officer (CFO) participation in the annual Western Region Flex Conference. 

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

Flex funding has supported the development, implementation and ongoing maintenance of the Nevada Instant Atlas. This interactive and user-friendly database has been developed for CAHs and other rural health providers, as well as rural public policymakers, rural health advocates, and the general public. Hundreds of variables and outcomes are showcased in maps, graphs and data resources that can be easily downloaded and used in research reports. Users can explore accurate and current data and discover disparities between social groups and health behaviors.

Nevada Flex Program assists CAHs with quarterly reporting by providing individualized and network TA and training. Each quarter, customized MBQIP data reports are distributed to all state’s CAHs. This information is used to monitor quality improvement, guide training, and educational activities. MBQIP Monthly is distributed to remind about reporting deadlines, new updates, and useful reporting tips.

Nevada CAHs are reporting improved HCAHPS, inpatient and outpatient and EDTC measures as a result of the collaboration's data collection and reporting activities. In 2018, Nevada Flex Program received the MBQIP Certificate of Achievement for state Quality Performance Improvement.

Do you have any hospitals interested in converting to CAH status?:


Program Statistics

Type of Organization University
Staffing 1.5 FTEs
Number of CAHs 13
Website URL Organization Website

Flex Program Staff

Gerald Ackerman
State Office Director, Nevada
(775) 738-1525
Laima Etchegoyhen
Flex Coordinator, Nevada
(775) 682-8471

Outreach and Technical Support Coordinator since January 2018

Jon Smith
Regional CFO, Nevada
(775) 827-4770
Becky Bayley
Director of Strategic Initiatives, Nevada
(775) 827-4770
Mary Tabor Griswold, PhD
Director, Health Workforce Research
(775) 682-8475

Specialty Areas / Background

  • Health services research
  • Geographic information system (GIS) research and mapping
  • Health workforce
  • Health economics

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.