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Vermont Department of Health

Top Flex Activities

Program Area: Support for Quality Improvement

  1. State QI network -- The Vermont Flex Program continues to work with the Vermont Program for Quality in Health Care (VPQHC) as a subcontractor to manage a network of quality directors and staff from eight critical access hospitals (CAHs) and one additional Small Rural Hospital Improvement Grant Program (SHIP)-eligible hospital. This Quality Network collaborates to increase reporting, processes and clinical outcomes in all four Medicare Beneficiary Quality Improvement Project (MBQIP) domains.
  2. Regional network – The Vermont Flex Program continues to work with our New England Flex Program peers through the NE Rural Health RoundTable’s to promote quality improvement (QI) certifications of interest to hospital QI and other staff. These include the Certified Professional in Patient Safety (CPPS), Certified Professional in Helathcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), Certification in Infection Control (CIC) and Trauma Nurse Core Certification (TNCC). At the request of several hospitals, the Vermonth Flex Program will be discussing expansion of this list to include nursing staff in other hospital settings, such as: Medical/Surgery, Pediatric & Adult Critical Care, etc.

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

Since 2015, six of eight CAHs have been reporting all Emergency Department Transfer Communication (EDTC) measures. All eight CAHs and rural hospitals have been reporting Hospital Consumer of Healthcare Providers and Systems (HCAHPS) measures for a decade or more as required by state statute.

Program Area: Support for Financial and Operational Improvement

CAH/SHIP hospital leadership visits: This year the Vermont Flex Program visited all  eight CAHs and the one additional SHIP-eligible hospital. Most of these meetings included the Quality Director, Chief Financial Officer (CFO) and Chief Executive Officer (CEO), plus other leaders if available, as well the State Office of Rural Health (SORH)/Flex/SHIP Director, local District Health Office Director and the Chronic Disease-Health System Director.  

Topics included discussion of priority concerns for the transition to a statewide accountable care organization (ACO) and All-Payer Model of reimbursement by 2020, review of hospital’s current Community Health Needs Assessments (CHNA) process and plans, discussion and clarification of Flex and SHIP grant programs and opportunities and rural health resources from the state and national partners.  

Meeting notes were shared with each hospital, as well as shared concerns and responses to resource requests. Themes will be identified from these notes and additional activities will be planned for Flex and SHIP Programs through 2020.

Most hospitals expressed concern about future of their CAH status and cost-based reimbursement under Vermont’s All-Payer Model agreement with the Centers for Medicare and Medicaid Services (CMS). Over the next year or so, the Vermonth Flex Program will be working closely with the hospitals, their association and national resources to identify potential strategies to ease these transition to value-based payments.

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

In 2017, the State EMS Director negotiated a contract for a pilot study on the potential impact of community paramedicine in several communities in Vermont. The Vermont Flex Program plans to compare data on 1-2 months of EMS transports to Emergency Departments (ED) to identify the following:

  1. Frequency distribution of all visits
  2. Billed claims on select avoidable visit types
  3. EMS transport records/notes for those visits
  4. EMS operator impressions of underlying issues for patients
  5. Suggestions/plans of what could be done to prevent avoidable ED visits
  6. Estimate of costs savings if avoidable visits were prevented. 

One of these strategies might be using shared savings for community paramedicine or other local preventive care activities to prevent avoidable emergency transports, admissions and costs. After some refinement, this study might be repeated in several other hospital service areas and, if successful, could then be rolled to the full state.

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

2017-18: In January 2018, the Vermont Flex Program visited all CAHs and the SHIP-eligible rural hospital to talk with leaders about their priority concerns as they approach a statewide ACO and implementation of Vermont’s All-Payer Model, and to identify how Flex and SHIP programs might help prepare them for that transition over the next several years.

Most CAHs reported their major concern was continuation of their CAH status and cost-based reimbursement under the All-Payer Model. They are also concerned about reimbursements and costs related to attributed lives that receive care in other communities or hospitals.

Most hospitals also expressed concern about the administrative burden of reporting quality data for MBQIP, in addition to CMS, NCHQ, State of Vermont and other agencies. This is especially frustrating when some measures are very similar but defined slightly different, causing recalculation of the same measure. Many CAHs are still collecting data manually for a few MBQIP measures, which is very time-consuming.

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

Rural/CAH Quality Network: The Vermonth Flex Program continues to work with the VPQHC program to manage a peer network of quality directors and staff from the CAHs and SHIP-eligible hospital. These folks meet quarterly to share information about collecting and reporting MBQIP measures and other QI issues. Again in October 2017, Karla Weng, Senior Program Manager, from Rural Quality Improvement Technical Assistance (RQITA), Stratis Health, was a guest speaker and presented on all four MBQIP domains as well as trends in quality reporting. 

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

The Vermont Flex Program continues to work with Flex and SORH peers from neighboring states on the New England Performance Improvement (NEPI) initiative through the New England Rural Health RoundTable. Through NEPI, rural hospital leaders and staff have access to a wide range of discounted or free online courses and webinars through the Institute for Healthcare Improvement (IHI); as well as certifications in Patient Safety, Healthcare Quality, Healthcare Risk Management, Infection and Disease Control and Trauma Nursing. The group will be expanding this list of certifications in 2018.

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

The Vermont Flex Program is just beginning to use the Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) and share information with CAHs.

Do you have any hospitals interested in converting to CAH status?:


Program Statistics

Type of Organization State Government
Staffing 1.35 FTE
Number of CAHs 8
Website URL


Flex Program Staff

John Olson
State Office Director, Vermont
(802) 951-1259

Specialty Areas / Background Areas

  • Budgeting for multi-funded projects
  • Coalition building
  • Meeting/Process facilitation
  • Grant writing
  • Program development

State Office Director since March 2010


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.