Texas State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

A critical access hospital quality improvement (CAHQI) initiative is continuing this year. The initiative is designed to bring together critical access hospital (CAH) staff and provide quality education programs through onsite workshops, webinars and conference calls. CAHs from across the state have been organized into four teams and each focus on one of the Medicare Beneficiary Quality Improvement Project (MBQIP) quality domains. Each team has been working to develop a process that will be made available for implementation by other CAHs in the state. The teams meet monthly and share:

  • Targeted technical assistance to increase the number of reporting sites through assistance collecting and analyzing data 
  • Education and training on process improvement techniques that will be provided to CAHs, both in-person and virtually as well as coaching calls and webinar

Last year, the vendor that was subcontracted for the quality improvement project created a dashboard which allowed CAHs in Texas to report emergency department transfer communication (EDTC) measures. This year, more measures have been added to the dashboard and will continue to be added. The great thing about the dashboard is that Quality Directors are able to see their progress in real time. Viewing the data in real time makes it easier to make changes since it is easier to remember what was done two months ago versus nine months ago. Another positive is that the dashboard is user-friendly.

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: 

The in-person workshops, as well as the regular webinars, are two contributing factors to CAH personnel reporting quality data. Workshop attendees have reported experiencing peer to peer support at the in-person workshops which has been increased participant’s knowledge. The support attendees increased their knowledge by communicating their successes and/or issues they have experienced/are experiencing.

The topics for the webinars are formed based on current MBQIP core measures. All of the webinars have been very well attended and the contributing reasons are the following: 

  • Always offered in the morning and the afternoon on Tuesdays
  • Information shared is relevant
  • Plenty of time for questions
  • Webinars are well organized

Another contributing factor to successful data reporting is the data guru that works on compiling and sharing the reported measures. This individual loves data and has the ability to explain everything in layman’s terms, while also being extremely accessible.

Program Area: Support for Financial and Operational Improvement: 

In this area, the Texas Flex Program:

  • Conducts CAH needs assessments, strategic planning process and utilization of the Flex Monitoring Team (FMT) reports to identify Texas CAHs in need of financial and operational improvement
  • Identifies specific CAHs in need of an on-site intervention for financial/operational condition assessment activity and provide on-site consultative and educational services
  • Collects baseline data and post evaluation data from activities, with a follow-up behavioral acceptance evaluation following the assistance
  • Provides technical assistance to hospitals that are interested in converting to CAH status
Program Area: Support for Designation of CAHs: 

If requested, the Texas Flex Program will provide technical assistance through conference calls and site visits, if necessary. Financial support for the feasibility study for CAH status conversion will also be provided.

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

Communication has been the primary vehicle used to inform CAH personnel that the overall system is transitioning to a value-based model. When presenting at the state CAH Conference, the Texas Flex Program shared the importance of reporting MBQIP measures and that reporting measures now is a great way to ensure that the facility will not be 'behind the eight ball' in the future. When visiting hospitals, Texas Flex continues to share the message regarding the transitioning to a value-based model.

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): 

Through their quality improvement (QI) vendor, the Texas Flex Program developed a CAHQI initiative, which will continue in the current funding cycle. In addition to the CAHQI Initiative, there will be six hospitals participating in a Rapid Cycle Team. The six hospitals that are selected will receive more in-depth technical assistance with a short term goal of demonstrating five percent improvement in overall MBQIP measures by three out of the six participants.

In the financial and operational improvement project, 10 hospitals will form two networks that will be located in different parts of Texas. Forming networks last year was successful and the Texas Flex Program decided to duplicate the project this year with a new set of hospitals to participate. Besides the goal of improving the financial and operational outlook of participating hospitals, cultivating relationships is a goal that was successfully met during the last funding cycle.

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

The CAHQI Initiative is still in the beginning stages, but the Texas Flex Program anticipates that it will become an example of a best practice in the future.

Program Statistics

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

Trent Engledow
State Office Director, Texas
(512) 463-6121

State Office Director since October 2016

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.