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South Carolina Office Of Rural Health

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Program Area: Support for Quality Improvement

The South Carolina Office of Rural Health (SCORH) provides quality improvement support through the Medicare Beneficiary Quality Improvement Project (MBQIP) and critical access hospital (CAH) collaborations. SCORH supports CAHs in implementing quality improvement activities to improve patient outcomes which include:

  • Improving patient and community safety, ensuring that health care providers and eligible patient populations receive influenza vaccinations
  • Supporting the improvement of patient experience of care through the use of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
  • Supporting the improvement of transitions of care from the CAH to other health care settings in order to improve patient outcomes
  • Supporting the improvement of the care provided in CAH outpatient settings in order to improve patient outcomes
  • Supporting the improvement of the care provided in CAH outpatient and emergency department settings through additional measures
  • Promoting and improving the reporting of quality of care data by CAHs through assisting all CAHs in the state to consistently publicly report data on all required measures by monitoring public reporting of required measures for all CAHs, providing technical assistance with reporting, outreaching to any CAHs who are not publicly reporting and determining barriers and providing resources and support to overcome barriers, root cause analysis to determine barriers to reporting outpatient care measures

Successes are measured by CAH participation in CAH quality meetings, publicly available data, technical assistance requests, quality improvement activities and shared best practices, along with completion of site visits, coaching calls, root cause analysis and action plans.

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

The SCORH Flex Program provided in-depth technical assistance for Outpatient (OP) measures to two of the non-reporting OP CAHs. Technical assistance was provided in the form of site visits, conference calls, and email support. Over fiscal year (FY) 2017, OP measure reporting to QualityNet was achieved; these two CAHs have not participated continually in OP measure reporting in the past. During this time, South Carolina's MBQIP Measure Abstraction Process was developed. The step-by-step process includes:

  • Engagement of hospital leadership
  • Electronic health record (EHR) query reports
  • Locating and updating the Centers for Medicare & Medicaid Services (CMS) Abstraction and Reporting Tool (CART)
  • QualityNet portal login
  • Follow-up with hospital leadership

The SCORH Flex staff will continue to utilize this process until all the state CAHs are reporting the four MBQIP domains. Even though MBQIP has been a main focus of Flex, there is still trepidation regarding MBQIP measure, reporting requirements and CART/QualityNet usage.

Program Area: Support for Financial and Operational Improvement

The SCORH Flex Program understands that operational and financial improvements in rural health care organizations are paramount to their ability to stay afloat in these dynamic times. SCORH actively works with each of the CAHS to improve their operations. In this area, South Carolina plans to support and assist CAHs by providing financial and operational in-depth assessments for CAHs to identify financial and operational strengths and challenges, and to identify statewide strategies for improvement. Activities include:

  • Perform inventory of CAHs' financial and operational indicators and distribute results of the inventory to individual CAHs
  • Support the CAHs with education and technical assistance related to preparing for new health care payment and delivery models
  • In-depth operational assessment to address identified improvement areas

Success is measured by participation in technical assistance activities, number of CAH/Chief Financial Officer (CFO) workgroup meetings, sharing of best practices, number of CAH Financial and Operational Assessments completed, number of site visits, action plans created and coaching calls completed.

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

In this area, South Carolina plans to support and assist CAHs by developing a statewide CAH population health management needs assessment to determine collective issues and trends in population health management for CAHs. Activities include:

  • Annual assessment of CAHs’ population health indicators, and distributing results of the assessment to individual CAHs and their community partners
  • Improve emergency medical services (EMS) capacity and operational projects by assisting CAHs to develop strategies for engaging with community partners and targeting specific health needs. This is achieved by identifying a performance improvement activity for each of the EMS agencies studied, developing an action plan, determining baseline and target measures based on performance activities and providing technical assistance via site visits and coaching calls to help in the implementation of the action plan and to develop collaborative linkages with the local CAHs based on the action plans

Success is measured by knowledge gained through the population health needs, number of performance activities identified, number of action plans created, baseline and target measures identified, number of site visits and coaching calls.

Please provide information about Collaboration/Shared Services

In an effort to understand and effectively communicate with partners on how the culture of EMS is different from more traditional health care providers, SCORH Flex staff continues to build and maintain relationships with and between agencies. During FY 2017, South Carolina CAHs started to explore innovative models that incorporate EMS as a trusted partner; the sharing of best practices allowed for greater interest in utilizing EMS outside of their traditional role.

Program Area: Support for Designation of CAHs

South Carolina provides activities that support appropriate conversion of small rural hospitals to CAH status. This is done by monitoring the state of all rural hospitals to determine the likelihood of conversion or closure as well as providing technical assistance as requested to communities seeking to convert to CAH status, decertify from CAH status or relocate/reopen/convert to other types of facilities. Success is measured by the status of rural hospitals reviewed semi-annually and at-risk facilities documented, and the number of technical assistance requests received.

Program Area: Support for Integration of Innovative Health Care Models

SCORH supports the integration of innovative health care models to develop/implement and assess innovative health care models designed to have a positive transformational impact on rural health in the state. Activities include: 

  • Technical assistance in improving outcomes and partner engagement
  • Identifying and distributing lessons learned and best practices during monthly network meetings
  • Using statewide data to identify CAHs who need extra assistance through site visits and partner engagement
  • Providing targeting strategic planning
  • Providing a statewide annual Population Health Summit with state partners for CAHs, rural health networks (RHN), community partners and stakeholders
  • Support the development of new provider types including community paramedics, community health workers, health coaches and care coordinators

Success for support is measured by number of technical assistance calls, emails and site visits; the number of RHN meetings held; the number of best practices shared; the number of CAH, RHN, community partners and stakeholders attending the Summit, and the number of stakeholder meetings hosted and attended.

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

SCORH's 2017 Annual Rural Health Conference, attended by all five CAHs along with their colleagues from rural health clinics (RHCs), RHNs and rural EMS, had a large focus on educating and supporting these CAHs, their communities and partner organizations in transitioning from volume-based care to value-based care by identifying transformational strategies and core competencies that improve this transition. Sessions included a focus on the Quality Payment Program, population health management, rural hospital closures and the current rural health care landscape.

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

There are six RHNs in South Carolina comprised of vertical network members, including CAHs, small rural hospitals, RHCs, federally qualified health centers (FQHCs), technical colleges, mental health and substance abuse treatment providers and local human service coordinating agencies. These networks meet monthly and work toward improving access to quality health care in their communities. In addition, there are two informal CAH workgroups that meet quarterly: one that is quality focused for Chief Nursing Officers (CNOs), Quality Directors and data abstractors and one that is finance focused for CEOs and CFOs. The two workgroups have one annual meeting each year to network, discuss their individual workgroup outputs and to get Flex Program updates. There is also a South Carolina Small Rural Hospital Improvement Grant Program (SHIP) Network, which includes all five CAHs plus three other small rural hospitals. This network is focused on financial benchmarking and ICD-10 implementation, which is coordinated with the Flex Program Operational and Financial Improvement program area.

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

The South Carolina Flex Program works closely with the South Carolina Hospital Association and Carolinas Center for Medical Excellence on an informal basis. Many quality programs overlap for the hospitals so these entities meet on a semi-regular basis to check-in on hospital and/or project status(es). Network activities are supported by another South Carolina Hospital Association collaboration, AccessHealth South Carolina. EMS activities are made possible by work with the South Carolina Department of Health and Environmental Control's Bureau of EMS and Trauma, four Regional EMS Offices, South Carolina EMS Association and the Joint Committee on Rural Emergency Care (JCREC).

SCORH also actively participates in the South Carolina Heart Care Alliance, bringing together ST-Elevated Myocardial Infarction (STEMI), stroke, sudden cardiac arrest and heart failure care under one umbrella group. In addition, SCORH is assisting in the development of Level IV Trauma Center criteria for South Carolina by chairing a sub-committee of the South Carolina Department of Health and Environmental Control Trauma Advisory Committee.

Lastly, the South Carolina Rural Health Action Plan, which is a collaborative endeavor of the South Carolina Rural Health Action Plan (RHAP) Task Force that was facilitated and led by SCORH, was released on November 16, 2017. The RHAP, a collective and comprehensive framework to enhance rural health outcomes, contains five areas of focus, 15 recommendations and more than 50 action steps intended to spur progress over the next three to five years.

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

SCORH and the South Carolina CAHs have been utilizing the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) throughout FY 2017; CAHMPAS is discussed at the quarterly CAH Quality Workgroup meetings.

Program Statistics

Type of Organization Non-profit
Staffing 2.0 FTEs
Number of CAHs 5
Website URL Organization Website

Flex Program Staff

Dr. Graham L. Adams
State Office Director, South Carolina
(803) 454-3850

Specialty Areas / Background

  • Provides overall supervision and direction for the South Carolina Office of Rural Health (SCORH)
  • Technical assistance to individuals and organizations regarding strategic planning, grant development, funding opportunities, infrastructure development and resource allocation
  • Collaborates with clinicians, administrators, educators, legislators, community and civic leaders and state and federal agencies to improve access to quality health care in rural communities

State Office Director since 2002

Sarah Craig
Flex Coordinator, South Carolina
(803) 454-3850

Speciality Areas / Background

  • Provides targeted support to rural hospitals, emergency medical service (EMS) systems and primary care providers in South Carolina

Flex Coordinator since 2017

Melinda Merrell
Senior Program Director, South Carolina
(803) 454-3850

Specialty Areas / Background

  • Provides oversight and guidance for all programmatic activities of the office
  • Former rural health network director in South Carolina

Senior Program Director since July 2010

Shannon Chambers
Director of Provider Solutions, South Carolina
(803) 454-3850

Specialty Areas / Background

  • Provides technical assistance in billing and coding, EHR implementation, and practice management for all Rural Health Clinics and associated Critical Access Hospitals

Director of Provider Solutions since

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.