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University of Nevada, Reno School of Medicine

Top Flex Activities

CAH Quality Improvement

The Nevada Flex Program and its principal program collaborator, the Nevada Rural Hospital Partners (NRHP), have succeeded in engaging all Nevada critical access hospitals (CAHs) in Medicare Beneficiary Quality Improvement Project (MBQIP) participation and reporting for the Fiscal Year (FY) 2018-2019 budget period requirements. For the last six consecutive quarters, 13 of 13 Nevada CAHs have been reporting Emergency Department Transfer Communication (EDTC) measures. Reporting for other MBQIP measures also improved, earning the Nevada Flex Program the certificate of achievement in recognition of the quality performance improvement by Federal Office of Rural Health Policy (FORHP).

During the current fiscal period, the Nevada Flex Program supported four in-person quarterly meetings of the Nevada Rural Hospital Flex Quality Improvement (QI) Network, a group of Nevada CAH QI and Risk Managers. Activities undertaken by the QI Network have been focused on facilitating CAHs’ participation in MBQIP reporting core measures. The QI Network has also supported quality improvement, patient safety, and risk management education and training. Individual technical assistance is being provided to each CAH as needed. Of note is the support provided for the technical aspect of the CART software, which has allowed several hospitals to meet their reporting deadlines in a more efficient manner.

In addition, the QI Network has begun to shift the emphasis of the quarterly meetings from reporting compliance to measure improvement by selecting individual measures focuses on as a group, allowing for the sharing of ideas and best practices. Data visualization charts are produced for the purpose of analyzing performance during the QI Network meetings, as well as for hospitals to utilize internally for their own quality improvement activities.

CAH Operational and Financial Improvement

The Nevada Flex Program and NRHP are implementing a wide range of technical assistance to support rural hospital financial and operational performance improvement. The Flex-supported Performance Improvement (PI) Network holds quarterly educational meetings to address issues raised by Nevada CAHs. In FY 2018-2019, meetings addressed topics such as coding boot camp, billing, and claims submission changes, denials, and claims process overall. Flex-supported technical assistance has also incorporated performance improvement assessment and interventions to any requesting Nevada CAH: Revenue Cycle Management; readiness assessments; gap analysis of current policies and procedures; assistance with the use of benchmarking core financial performance indicators; and hospital staff training on the use of RCM and other performance improvement tools. Additional technical assistance provided to hospital staff on the use of dashboard development and maintenance, annual budget preparation, audit and cost report preparation, and reporting financial information to hospital trustees and stakeholders. 

In FY 2019-2020, the Nevada Flex Program will continue the Performance Improvement (PI) Network meetings and other performance improvement technical assistance described above. In addition, NRHP will assist any requesting CAH in Nevada with in-depth assessment of PI strength, problems, and opportunities to improve financial and operational performance, and implement customized performance improvement action plan for CAHs receiving in-depth assessment. 

CAH Population Health Improvement

For the past two decades, the Nevada Flex Program has supported a variety of technical assistance to further rural population health management, 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.

Rural Emergency Medical Services (EMS) Improvement

Flex funding contributed to the EMS integration and development in rural communities served by Nevada CAHs. The Annual Rural Nevada EMS Conference is held in September in Elko. On average, nearly 300 emergency medical technicians (EMTs) and other professionals representing 60 services from Nevada, California, and Utah attend this conference. 

In FY 2019-2020 Nevada Flex Program will administer a statewide and community level rural EMS needs assessment to determine the specific needs of rural EMS providers, agency concerns in the areas of EMS education, billing/reimbursement, recruitment and retention, and trauma system involvement.

Innovative Model Development 

The Nevada Flex Program continues to support CAH participation in Project ECHO Nevada, which 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 rural primary health care provider retention.

In August of 2019, Project ECHO Nevada team visited 11 of 13 Critical Access Hospitals and met with medical staff in each hospital to introduce ECHO and learn how to better serve rural medical staff needs.

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

For over a decade, the Nevada Flex Program has continued to support quarterly meetings for the state’s CAHs to develop and implement network-based strategies to facilitate the transition to value-based care and improved population health management, including:

  • The Nevada Rural Hospital Quality Improvement (QI) Network, which focuses on MBQIP measures such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), inpatient and outpatient, and EDTC measures. This group also meets in conjunction with the Risk Manager Work Group, which emphasizes initiatives that improve patient safety. Once a year, Directors of Nursing are invited to this meeting to focus on important clinical.
  • The Infection Control Work Group, which facilitates the development and implementation of infection prevention and antibiotic stewardship programs and capacity in Nevada CAHs.
  • The PI Network, which focuses performance improvement assessment and interventions to any requesting Nevada CAH: Revenue Cycle Management (RCM); readiness assessments; gap analysis of current policies and procedures; assistance with the use of benchmarking core financial performance indicators; and hospital staff training on the use of RCM and other performance improvement tools.

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

For the past 17 years, the Nevada Flex Program has collaborated with colleagues in Arizona, California, Hawaii, New Mexico, Utah, and other western states to support CAHs' Chief Executive Officers (CEOs) and members of the Performance Improvement (PI) and Quality Improvement (QI) Networks participation in the annual Western Region Flex Conference. 

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

The Nevada Flex Program is partnering on two projects with Renown Health in Reno, Nevada. The first project is to provide a Rural Trauma Team Development Course onsite at CAHs. Participants include the hospital’s medical staff, local law enforcement, and local Emergency Medical Services (EMS). The second project is on data analysis for the outmigration of rural patients for treatment.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization University
Staffing (FTE) 2.66
Website Organization Website 
Number of CAHs 13

Flex Program Staff

Gerald Ackerman
State Office Director, Nevada
(775) 738-1525

Assistant Dean, Rural Health; Director, Office of Rural Health; Director, Nevada AHEC Program.

John Packham
Associate Dean, Office of Statewide Initiatives, Nevada
(775) 784-1235
Laima Etchegoyhen
Flex Coordinator, Nevada
(775) 682-8471

Outreach and Technical Assistance Coordinator since January 2018

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

Specialty Areas / Background

  • Health services research
  • Geographic information system (GIS) research and mapping
  • Health workforce
  • Health economics
Blayne Osborn
Flex Staff, Nevada
(775) 827-4770

Research Analyst, Nevada Rural Hospital Partners

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, $1,009,121 (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.