Pennsylvania State Flex Profile
Top Flex Activities
The Pennsylvania Office of Rural Health (PORH) hired a full-time Quality Improvement (QI) Coordinator this budget year that will work directly with the Pennsylvania critical access hospitals (CAHs) to assist the hospitals in their improvement efforts in the Medicare Rural Hospital Beneficiary Project (MBQIP). The QI Coordinator will visit each CAH and review the hospital's MBQIP reports and identify a specific improvement project for focus during the current budget year. Baseline data will be identified and subsequent improvement recorded.
During the 2015-2016 budget year, the Pennsylvania CAHs completed a project improvement program with a subcontractor. The project included an initial meeting where a hospital project was identified, a mid-year check-in webinar and a summary meeting where the results were shared with the CAH Chief Executive Officer (CEO).
Pennsylvania CAHs will benchmark their financial and quality metrics against other CAHs and prospective payment system (PPS) hospitals using the Hospital Strength Index. The index, market, value and finance percentile ranks will be compared against peer hospitals and previous year performance. The Pennsylvania Flex Program will provide the service to the Pennsylvania CAHs to collect and analyze their Medicaid cost reports prior to submission to the Commonwealth's Medicaid agency in order that the CAHs receive a Medicaid supplemental (based upon 101 percent reimbursement).
The average supplemental per hospital is over $1 million. An operational area for improvement in this current program year is to improve the operations of the CAHs' affiliated primary care practices. The September 2016 CAH Quarterly meeting focused on value-based payment in strategies for primary care. The subsequent meeting included presentations by the Pennsylvania Department of Health on the Global Budget Model for Rural Hospitals in the Commonwealth.
Through the use of the Health Communities Institute (HCI) system, select Pennsylvania CAHs are using this system to assist with the development of their community health needs assessments (CHNA) using the vast array of community health data and best practices. PORH hosts the data for these counties on its website for public use. Both county level and rural regional data can be accessed through the website.
Working in collaboration with the Pennsylvania Trauma Systems Foundation (PTSF), one Pennsylvania CAH achieved Level IV designation while two other Pennsylvania CAHs are advancing towards level IV trauma designation. Two other rural hospitals have converted to level IV. Both the PPS and CAH hospitals are all submitting data to PTSF. A new Trauma Recognition Program is also in the developmental stage, which could increase rural trauma data reporting from non-designated hospitals.
PORH is represented by the Rural Health Systems Manager and Deputy Director on the Pennsylvania Department of Health's Pennsylvania Population Health Committee, one of five committees organized to assist the Commonwealth with its Health Innovation Plan.
Pennsylvania has had a renewed interest in hospitals seeking CAH designation. Since December 2014, three hospitals have converted to CAH designation, with the most recent occurring in November 2016. None of these hospitals were originally considered in 2001 for designation since all were over 50 beds. Two of the hospitals were approved with the secondary road waiver while one used the mountainous terrain waiver. The use of GIS technology assisted in identifying the necessary terrain necessary to meet the Centers for Medicare & Medicaid Services (CMS) regulations.
PORH is participating with the College of Engineering at Penn State University in their work with the National Science Foundation-sponsored Center for Health Organization Transformation (CHOT) consortium of national universities. PORH has been identified to participate in the CHOT focus areas for 2016-2017 that include population health, payment models, workforce training, home care, operations and care coordination. The Fall 2016 CHOT National Meeting was hosted by Penn State where a representative of the Healthy Communities Institute participated.
PORH has hosted two meetings where presentations by the Pennsylvania Secretary of Health and the Deputy Secretary of Health have presented to both CAHs and other small rural hospitals on the new Global Budget Model for rural hospitals. The second meeting was hosted in collaboration with the Hospital and Healthsystem Association of Pennsylvania (HAP).
In addition to the work with PTSF, the Pennsylvania Flex Program works with a number of other state agencies to help support the CAHs. The HAP is a valuable partner in advocating for the Medicaid Supplemental funding for the CAHs. HAP is also invited to the quality improvement meetings to update the CAHs on the Hospital Engagement Networks in the state. Both the Pennsylvania Academy of Family Physicians and the Pennsylvania Association for Community Health Centers are value partners in assisting with the Primary Care workforce. PORH also serves on the eHealth Partnership Authority committee for safety net providers in the Commonwealth for health information exchange.
The Pennsylvania Flex Program has most recently had cross-state collaboration with HCI, which hosted a meeting of HCI users that included hospitals and organizations from Pennsylvania, New York, Maryland and the District of Columbia. The organizations shared their best practices and how the use the population health data and best practices in their communities. In the past, Pennsylvania has collaborated with the New York State Office of Rural Health in holding a joint meeting of CAHs.
The efforts that revolve around the Medicaid Supplemental Program would certainly be considered most valuable by the CAHs. Due to a Commonwealth budget crisis this past fiscal year, PORH, the CAHs and HAP came together to impress upon state government the importance of the Medicaid Supplemental Program for the survival for the CAHs. The program generates on average just over $1 million per CAH. For most of the CAHs, this is the difference in a positive bottom line. Each fiscal year funded by the Flex Program the CAHs submit their MA 336 cost reports for review and subsequent submission to the Commonwealth's Medicaid agency. PORH and HAP work with the legislature to include the supplemental payment into the budget each year.
Flex Program Staff
Specialty Areas / Background
- Public health and policy
- Special populations
State Office Director since June 1999
Specialty Areas / Background
- Deputy Director
- Hospital management
- Physician office management
- Human resources
Flex Coordinator since February 2001
Quality Improvement Coordinator since September 2016
Budget Assistant since May 2015