Virginia State Flex Profile
Top Flex Activities
The Virginia State Office of Rural Health (SORH) partners with the Virginia Hospital and Healthcare Association (VHHA) to implement the Virginia Rural Hospital Coaching Collaborative (Collaborative) in an effort to support quality and operational improvement for all Virginia Small Rural Hospital Improvement Grant Projects (SHIP) eligible hospitals. This group was previously called the Virginia Rural Hospital Studer Group Coaching Collaborative. The hospital association brings in speakers for the quarterly Leadership Development Institutes from expert organizations that further the “hardwiring excellence” Studer Group concepts. Dashboards are used to measure quarterly improvements in quality (and operations). An ancillary improvement in financial outcomes has been experienced by some participating hospitals.
Virginia CAHs received the Federal Office of Rural Health Policy (FORHP) Medicare Beneficiary Quality Improvement Project (MBQIP) Certificate of Excellence for the second year in a row. Intensive quarterly trainings for data extraction, reporting and comparative data analysis continues to be facilitated by a contracted firm known nationally for its successful work with small rural hospitals. CAHs are measured against national benchmarks, state-level benchmarking and other Virginia CAHs.
The Virginia Rural Hospital Coaching Collaborative supports operational and financial improvements for the 12 participating Virginia SHIP-eligible hospitals. Four critical access hospitals (CAHs) are participating in the Collaborative. Two CAHs not participating in the Collaborative were identified to receive in-depth financial assessments under Objective 2.2 of the Flex Program. The contractor carrying out this portion of the work plan traveled to both CAHs and spent a day reviewing each hospital’s financial and operational reports and procedures. Each CAH along with the Virginia SORH received draft comprehensive reports reviewing findings and providing recommendations for improvement. The contractor has scheduled times with each hospital to review findings and recommendations before finalizing the report.
Data collection regarding integration of emergency medical services (EMS) into Virginia rural health care delivery systems occurred during CAH site visits. CAHs discussed their current relationships with their local EMS providers and talked about models for which they would like Flex Program support in strengthening and expanding those local EMS relationships. The Virginia SORH is evaluating several options regarding how best to move forward with integrating EMS.
Virginia has one newly designated CAH as of May 2016. The State Flex Coordinator continues to provide support and technical assistance to another previously closed SHIP-eligible hospital that is completing the CAH Designation Application process.
The Virginia Hospital and Healthcare Association (VHHA) offered Virginia SHIP-eligible hospitals a Leadership Development Institute (LDI) that incorporated key Trustee/Board members and top physicians and nurses into the activities of the day. Several Board members were hearing about the necessary transition to value-based care and payments for the first time and had many questions that led to robust discussions and learning. LDIs are offered quarterly for Collaborative participants who also participate in Coaching Collaborative Conference Calls between LDIs.
The Virginia CAH Network provides a forum for interactive CAH trainings. Some CAH leaders have expressed their lack of time to engage in research to stay abreast of constantly occurring policy changes. Hospital administrators say they want these sessions to continue to provide them with a means to access this information that is vital to their ongoing existence. A contractor provides quarterly metrics regarding network activities.
The Virginia SORH maintains its relationship with the Virginia Rural Health Association to maintain consistent interactions with key rural partners with the intended outcome of improving activities and working together to maintain a finger on the pulse of rural Virginia’s key priorities. The value of this relationship is measured by the growing number of statewide rural partners connecting with the SORH.
The SORH maintains a partnership with the United Way of Greater Richmond and Petersburg (UW), which is measured by whether the UW board adopts recommended concepts of community engagement and collaboration among leaders throughout the region.
The Virginia Rural Work Group is a think tank regarding improving determinants of health for all rural Virginians from a policy and legislative perspective. The SORH recommended the development of legislation language be added to the Virginia Code designating all Virginia CAHs as “located in rural areas” of the Commonwealth of Virginia.
The Virginia Rural Hospital Coaching Collaborative is a best practice that has yielded a return on investment that was unexpected. Participating hospitals have experienced improvements in employee satisfaction. Most hospitals report improvement in their HCAHPS scores and report, along with operational improvements, an ancillary improvement in financial outcomes. Virginia SORH is collaborating with the Virginia Hospital and Healthcare Association to develop a model that will encourage nonparticipating SHIP-eligible hospitals (including CAHs) to participate in the Collaborative. Out of 24 SHIP-eligible hospitals, 20 have expressed an interest in being included in this venture. Of the 20 interested hospitals, six are CAHs, and four of those CAHs have not previously participated in the Collaborative.
Flex Program Staff
Director, Division of Primary Care and Rural Health since September 2015