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South Carolina Office of Rural Health

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CAH 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 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
  • Supporting the improvement of reporting quality of care data

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 the completion of site visits, coaching calls, root cause analysis, and action plans.

CAH Operational and Financial 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:

  • Performing inventory of CAH financial and operational indicators and distributing inventory results to individual CAHs
  • Supporting CAHs with education and technical assistance related to preparing for new health care payment and delivery models
  • In-depth operational assessment addressing identified improvement areas

Success is measured by participation in technical assistance activities, the number of CAH and 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.

CAH Population Health Improvement

SCORH supports CAHs identifying community and resource needs through community assessments and focused trainings. To be successful, CAHs must understand the needs of the communities they serve. Through this program area, SCORH will help CAHs understand their communities more fully and gain the proper tools and education to serve them efficiently. These activities will include:

  • CAH community assessments for unmet healthcare needs and root causes of poor health
  • Provide training on Internal Revenue System's (IRS) reporting requirements and best practices for community health needs assessments (CHNAs)
  • Sponsor conference attendance and provide Community and Population Health trainings to CAH staff

Each CAH and their community will be involved in this program area. Success will be measured by the number of communities assessed, the number and type of recipient of assessments distributed, and the number of CAH staff who receive community-based trainings. 

Rural Emergency Medical Services (EMS) Improvement

In previous years, SCORH has accessed the rural EMS agencies in counties with a CAH. These results are compiled, analyzed, and distributed back to the EMS agencies and CAHs in a blinded report. SCORH will expand that assessment to include all counties in South Carolina to provide a more complete picture of EMS throughout the state. The annual assessment will also be paired with a workforce focused assessment as workforce has consistently been identified as an area of concern for our rural EMS agency leadership.

SCORH will improve 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 EMS agency 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 an action plan. Collaborative linkages are developed with the local CAHs based on their action plans.

The combination of these two assessments will allow for a more detailed conversation with rural EMS agencies and providers regarding their needs for a sustainable future. Success will be based on the number of site visits, assessments completed, areas of improvement identified, and reports distributed.

If your Flex Program was funded for one of the eight competitive Flex EMS awards, please describe your project, your partners, and intended long-term outcomes.

SCORH understands the significant role EMS plays in healthcare. Through this supplement, SCORH seeks to build the capacity of rural EMS agencies through the continued support of existing innovative models of care and development of pilot programs to provide new avenues of sustainable care. These programs will be focused towards the rural counties in South Carolina which do not have a hospital, therefore, see some of the heaviest burdens placed on EMS. SCORH activities include:

  • Expansion of Community Paramedic Programs into new agencies and counties
  • Develop a pilot program for Alternative Destinations and implement in targeted rural EMS agencies
  • Develop a pilot program for Treat-No-Transport and implement in targeted rural EMS agencies

Through the partnership with the South Carolina Department of Health and Environmental Control, along with the rural EMS agencies, SCORH seeks to engage with and implement these programs into rural areas. The pilot programs, once approved, will then be available for all EMS agencies and counties to utilize and build toward more sustainable avenues of care.

Innovative Model Development

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

  • Technical assistance for improving outcomes and partner engagement
  • Facilitating rural hospitals entering the South Carolina Trauma System
  • Identifying and distributing lessons learned and best practices during monthly network meetings
  • Using statewide data to identify CAHs in need of extra assistance through site visits and partner engagement
  • Providing targeted 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 the 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 network activities in your state to support Flex Program activities.

There are four active 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 to 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 meeting each year to network, discuss individual workgroup outputs, and get Flex Program updates. There is also a South Carolina Small Rural Hospital Improvement Grant Program (SHIP) Network, which includes all four CAHs, plus ten other small rural hospitals. This network is focused on financial benchmarking and ICD-10 implementation, which is coordinated with the Flex Program's 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 Carolina's 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 working with the South Carolina Department of Health and Environmental Control's Bureau of EMS and Trauma, four Regional EMS Offices, the South Carolina EMS Association, and the Trauma Advisory Council. 

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

The South Carolina Office of Rural Health led a statewide effort to develop a Rural Health Action Plan (RHAP). This document details the needs of rural communities across the state, around many viewpoints of what defines a healthy community. This work was completed with the help of many non-traditional partners across a spectrum of professional fields and areas of expertise. This document, which can be found on the SCORH website, will provide a roadmap for rural work going forward. 

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization Non-profit Organization
Staffing (FTE) 2
Website Organization Website
Number of CAHs 4

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

Specialty Areas / Background

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

Flex Coordinator since 2017

Britton Herbert
Health System Innovation Program Manager, South Carolina
(803) 454-3850

Provides targeted support to rural hospital and emergency medical service (EMS) systems in South Carolina. Focus on rural engagement in Trauma System.

Health System Innovation Program Manager since 2019

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 (RHC) and associated critical access hospitals (CAH)

Director of Provider Solutions since 2014

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, $1,560,000 (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.