Pennsylvania State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

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.

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: 

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).

Program Area: Support for Financial and Operational Improvement: 

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.

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

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.

Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

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.

Program Area: Support for Designation of CAHs: 

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.

Program Area: Support for Integration of Innovative Health Care Models: 

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.

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

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).

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): 

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. 

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

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.

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

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.

Program Statistics

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

Lisa Davis
State Office Director, Pennsylvania
(814) 863-8214

Specialty Areas / Background

  • Public health and policy
  • Special populations

State Office Director since June 1999 

Larry Baronner
Flex Coordinator, Pennsylvania
(814) 863-8214

Specialty Areas / Background

  • Deputy Director
  • Hospital management
  • Physician office management
  • Human resources

Flex Coordinator since February 2001 

Lannette Johnston
Quality Improvement Coordinator, Pennsylvania
(814) 863-8214

Quality Improvement Coordinator since September 2016

Derek Hartman
Graduate Student Intern, Pennsylvania
(814) 863-8214
Laura Zimmerman
Budget Assistant, Pennsylvania

Budget Assistant since May 2015

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.