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Vermont Department of Health

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Program Area: Support for Quality Improvement

The Vermont Flex Program continues to work with the Vermont Program for Quality in Health Care (VPQHC) as a subcontractor to manage a state Quality Improvement (QI) network of quality directors and staff from the eight critical access hospitals (CAHs) and rural mid-size hospitals. This Quality Network collaborates to increase reporting, processes and clinical outcomes in all four Medicare Beneficiary Quality Improvement Project (MBQIP) domains. CAHs report status updates each quarter to the sub-grantee and the State Office of Rural Health (SORH).

The Vermont Flex Program continues to work with the New England (NE) Flex Program peers through the NE Rural Health Association to support educational opportunities for quality and clinical staff at rural hospitals and other health care providers. Specifically, reimbursement fees are provided for certifications that include the Certified Professional in Patient Safety (CPPS), Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), Certification in Infection Prevention and Control (CIC), and the Trauma Nursing Core Course. At the request of several hospitals, list of certifications and eligible staff have expanded to include other health care settings in rural communities. The subcontractor, the Northeast Regional Health Authority (NERHA), submits quarterly reports to all four SORHs with the names of participants, health care facilities, states, certifications, and completion dates.

Since 2016, seven of eight Vermont CAHs have been reporting all Emergency Department Transfer Communication (EDTC) measures. All eight CAHs and rural hospitals have been reporting Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures for a decade or more as required by statute.

Program Area: Support for Financial and Operational Improvement

In January and February of 2018, the Vermont Flex Program visited all eight CAHs and one additional SHIP-eligible hospital for CAH/Small Rual Hospital Improvement Grant Program (SHIP) Hospital leadership visits. 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 SORH/Flex/SHIP Director, local District Health Office Director, and Chronic Disease Health Systems Director. 

Topics discussed included:

  • 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;
  • 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 the 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 Vermont Flex Program will be working closely with the hospitals, their association, and national resources to identify potential strategies to ease the transition to value-based payments.

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

In 2017, the Vermont State Emergency Medical Services (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 one to two months of EMS transports to Emergency Departments to identify the following: 

  • frequency and distribution of all visits;
  • billed claims on select avoidable visit types;
  • EMS transport records/notes for those visits;
  • EMS operator impressions of underlying issues for patients;
  • suggestions/plans of what could be done to prevent avoidable ED visits;
  • and 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.

Please provide information about Collaboration/Shared Services 

All 14 Vermont hospitals have updated their CHNA in 2018. The SORH is reviewing these completed CHNAs for themes across hospitals, especially CAHs, to identify potential shared projects and education opportunities for 2019-2024.

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

In January 2018, the Vermont Flex Program visited all eight CAHs and one additional 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. These discussions included identifying how the 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 Medicare Beneficiary Quality Improvement Project (MBQIP), in addition to the measures requested by CMS, National Hospital Qualit Measures, 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.

The Vermont Flex Program continues to work with the VPQHC program to manage a peer Rural/ CAH Quality Network of quality directors and staff from eight CAHs and one additional SHIP-eligible hospital. The network meets quarterly to share information about collecting and reporting MBQIP measures and other QI issues. In September 2018, several speakers presented on policy, resources and trends in hospital quality reporting. The Flex and SHIP Coordinator was one of these presenters.

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 the NE Flex Program peers through the NEPI Initiative to support educational opportunities for quality and clinical staff at rural hospitals and other health care providers. Specifically, the NE Flex Programs provide reimbursement fees for certifications that include the CPPS, CPHQ, CPHRM, CIC, and TNCC. At the request of several hospitals, the Flex Programs have expanded the list of certifications and eligible staff to include other health care settings in rural communities. The subcontractor, NERHA, submits quarterly reports to all four SORHs with the names of participants, health care facilities, states, certifications, and completion dates.

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

The Vermont Flex Program is working with state and national partners to review QI, financial, and population health data over time for CAHs and other rural hospitals to identify areas of improvement for each CAH for 2019-2024. The subcontractor/partner, VPQHC, will be reviewing MBQIP data trends and weaknesses. The Vermont Flex Program will use information from the health care regulation body, the Green Mountain Care Board (GMCB), to analyze the hospital financial data in annual public statewide reports. The Vermont Flex Program will also review priorities identified by hospitals in their 2018 CHNAs. Nationally available data will be used from Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS), where appropriate, if it is more current than state available data.

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

No

Program Statistics

Type of Organization State Government
Staffing 1.1 FTEs
Number of CAHs 8
Website URL Organization Website
 

Flex Program Staff

John Olson
State Office Director and Flex Coordinator, 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 and Flex Coordinator 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.