Utah State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The Utah Flex Program supports the rural independent hospitals by canvassing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) vendor market and summarizing options. The decision was made to collectively contract with one HCAHPS vendor with a discount on pricing. Participating hospitals gave permission to the Flex Coordinator to access real-time HCAHPS data from this vendor. The Flex Coordinator summarizes the data on a monthly basis and distributes to participating CAHs. Trends are monitored and best practices shared in areas of decline or deficiency. Discussion of HCAHPS best practices is also part of regular rural independent hospital nurse manager group meetings.

The Flex Coordinator has developed spreadsheets for each independent CAH with individual graphs for each emergency department transfer communication (EDTC) measure. As data is submitted on a monthly basis, the Flex Coordinator updates these graphs and distributes to CAHs in real time, with observations about trends. CAHs are asked to provide feedback on causes of trends. Processes and procedures that have been effective in improving EDTC measures are shared with all CAHs.

The Flex Program continues to support the nurse managers of the rural independent hospitals in the state. This group is meeting three times a year, taking turns meeting at their respective hospitals. The nurse managers are engaged and enthused about these meetings, which last two days and cover a myriad of topics. They have the opportunity to network and share best practices. 

One quality improvement program that developed from this group is hands-on training at the University of Utah Hospital, which is a teaching and tertiary care hospital. Nurses from the rural hospitals spend several days at the University hospital shadowing and obtaining hands-on training in Labor & Delivery, Surgical Services, Peripherally Inserted Central Catheter (PICC), Emergency Department (ED) and Intensive Care Unit (ICU). This program has been highly successful in providing training for rural nurses that lack experience given lower patient volumes in their rural hospitals.

Utah Flex has initiated the organization of a quality coordinator group of the rural independent hospitals. The first meeting was held on August 30, 2016. All hospitals were represented, and there was much enthusiasm for organization of the group and working together collaboratively moving forward. A follow-up meeting was held on September 22, 2016 and plans were made to hold the next meeting in the spring of 2017. 

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 Utah Flex Coordinator has developed spreadsheets for each independent CAH with individual graphs for each EDTC measure. As data is submitted on a monthly basis, the Flex Coordinator updates these graphs and distributes to CAHs in real time, with observations about trends. CAHs are asked to provide feedback on causes of trends. Processes and procedures that have been effective in improving EDTC measures are shared with all CAHs.

By continuously providing feedback real-time on EDTC data received from all CAHs, all the rural independent CAHs have made significant improvement over time.

Program Area: Support for Financial and Operational Improvement: 

Three CAHs are participating in the collaborative three-year StuderGroup operational improvement program. This collaborative program reduces the cost significantly versus each hospital participating individually.

Utah Flex continues to collaborate with the University of Utah Hospital and other hospital systems to provide programs and services to the rural independent hospitals at very low to no costs. One example is the regional department manager training workshops. Experienced and well-trained individuals at the University's human resource department conduct the training at the workshops. By providing the training regionally, the travel burden and cost is reduced significantly. Other collaborative programs include revenue cycle improvement, hands-on nurse training program and employment law education.

Regular site visits allow the Flex Program to assess the status of the CAHs. When it is determined that a CAH is trending toward financial failure and/or financial hardship, interventions are initiated to provide assistance. Examples of effective interventions include: asking hospital system in the state to send their rural hospital financial team onsite to assess financial condition and provide recommendations, requesting a seasoned retired rural hospital Chief Executive Officer (CEO) to mentor an interim CEO to stabilize management and coordinating help from a seasoned Chief Financial Officer (CFO) to visit the facility and report to the board on recommended operation and policy changes.

The Flex Program is also supporting multiple hospitals with revenue cycle assessments being conducted by consultants. One of the objectives of this initiative is to be able to compare financial successes between the participating hospitals.

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

The Flex Program is working with the Bureau of Emergency Medical Services (EMS) on a project to identify and recognize resource hospitals for all EMS agencies. Additionally, the Flex program and the Bureau of EMS are providing rural trauma team development courses (RTTDC) for all rural hospitals. This is in conjunction with helping CAHs who desire to become recognized stroke receiving facilities and/or achieve trauma designations. The trainings provided in this effort are attended by both hospital and EMS personnel. Enhanced relationships between the hospital and EMS personnel are already being seen as a result of these trainings.

Program Area: Support for Designation of CAHs: 

The Flex Program previously assisted a rural hospital in developing CAH policies and procedures through a qualified vendor. This rural hospital converted to CAH on July 1, 2016. Additionally, the program is working with a second hospital who intends to convert to CAH status beginning January 2017.

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

The Flex program continues to provide information and resources concerning the transition to value-based care to all CAHs.

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): 

A formal network of the nine rural independent hospitals in the state was organized in 2013. The network has articles of incorporation and by-laws, with the board chair position filled by a hospital chief executive officer (CEO). The Flex program works closely with this group to help advance programs and projects that take advantage of economies of scale with nine hospitals as a group, versus each hospital alone. There have been successful programs implemented to help this group of hospitals, mainly along the lines of financial and operational improvement. For example, the hospitals entered into an agreement with a law firm in the state to provide unlimited initial legal advice and assistance for a nominal monthly fee. Other programs include a common insurance broker for property insurance, mobile MRI and GPO services. Subgroups have been formed to network and share best practices, including nurse leaders, human resource managers and quality coordinators. The network continues to grow and has taken on a part-time Executive Director.

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

The value of collaborative networks has been established. The network of the nine rural independent hospitals in the state has been a success in providing services and programs at discounted rates and with sharing of best practices. Additionally, functional groups have been established for human resource directors, quality coordinators and nursing directors. The success of these functional groups is also leading to the formation of additional collaborative groups.

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

Matt McCullough
State Office Director, Utah

Specialty Areas/Background

Matt McCullough is the current Director of the Utah Office of Primary Care and Rural Health. He previously was a Senior Research Analyst within the office and responsible for the PCO program. Matt has over 10 years of experience with GIS and spatial/data analysis and is completing a doctorate degree in medical/health geography.

State Office Director since August 2017

Greg Rosenvall
Flex Coordinator, Utah
(801) 793-0426

Specialty Areas / Background

Prior critical access hospital administrator for 15 years

Flex Coordinator since September 2011

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.