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Virginia Department of Health

Top Flex Activities

CAH Quality Improvement

Virginia Rural Hospital Coaching Collaborative (VRHCC)

Historically, the VRHCC has been offered as a Small Hospital Improvement Program (SHIP) program menu option, which gives rural hospitals the opportunity to network, share, and implement strategies for quality, financial, and operational improvement through evidence-based coaching. In Fiscal Year (FY) 19, the Flex Program will be implementing the collaborative as a Flex programmatic activity, which will be offered to SHIP participating hospitals as well. The need-based education is directly stemmed from the one-on-one calls with hospitals, in which many expressed the desire for additional resources toward addressing certain quality initiatives. The VRHCC offers rural hospitals an opportunity for peer sharing and learing, access to subject matter expert (SME) coaching and resources, and a registration-waivered fee to attend local conferences, such as the Virginia Patient Safety Summit, Virginia Hospital and Healthcare Association (VHHA) Annual Meeting, and Healthcare Leadership Institute.

MBQIP Dashboards

Aligning with the goal of increasing quality reported data, and then driving quality improvement activities based on data, the Virginia Flex Program will be investing in Medicare Beneficiary Quality Improvement Project (MBQIP) interactive dashboards. The MBQIP dashboards will drill down the measures to the hospital level and benchmark amongst the state averages and the national benchmarks (90th percentile). The dashboards will be updated quarterly as the Telligen reports are distributed by the Flex Program Project Officer. This activity was identified as a need by the lack of forward progress or improvement in many of the MBQIP quality measures.

Antibiotic Stewardship & Addressing Health-Acquired Inflections (HAI) Webinar Series & Site Visits

The Flex Program is collaborating with the Virginia Department of Health (VDH), Division of Surveillance and Investigations (DSI) and Healthcare-Associated Infections (HAI), and the Antimicrobial Resistance Program to host a webinar series around Antibiotic Stewardship and Healthcare Acquired Infections. The webinar took place in November 2019, during National Antibiotic Awareness Month. HAI stakeholders, such as the Virginia Hospital and Healthcare Association Foundation (VHHAF),  Virginia Quality Improvement Organization, and Healthcare Quality Innovators, will be invited to observe and participate. The webinars will be conducted every other month and participation will be open to both the critical access hospitals (CAHs) and small rural hospitals throughout the Commonwealth, as a way for like-hospitals to network and share resources and best practices.

During the Virginia General Assembly, HB1570 was passed, requiring healthcare facilities, including ambulatory surgery centers, CAHs, dialysis facilities, long-term acute care facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities, to report HIAs to VDH. To ensure CAHs have the capability to report HAIs, as well as implement effective strategies to combat HAI, the Program Antimicrobial Resistance Coordinator, and HAI Epidemiologist will be visiting two CAHs a year to conduct an in-depth onsite analysis of the hospitals’ antibiotic stewardship programs, procedures, and processes. The hospital will receive a pre-visit survey/assessment that will provide the HAI team insight on current processes. The team will conduct a facility tour and key-person interviews. After the site visit, the HAI program team will present the hospital with a report containing their findings and follow-up action plan. Concluding each program year, they survey and reach out to their CAHs for constructive feedback and initiate a process improvement lens to their activities.

CAH Operational and Financial Improvement

Virginia CAH Financial Indicator Scorecard

A spotlight was shinned upon the state of Virginia’s rural hospital finances as if it was a shocking development that took place overnight. Aligning with the goal of improving financial and operational performance, the Virginia Flex Program will be creating a financial scorecard utilizing the top nine rural-relevant hospital financial indicators identified by the National Rural Health Resource Center. Using the Virginia CAHs Medicare Cost Report data, the financial scorecards will drill down the financial indicators to the hospital level and benchmark amongst the state average and the national benchmark (90th percentile). The scorecard will be updated annually and will be used to readily identify opportunities for improvement, training, and resources for CAH-specific financial and/or operational improvement.

Charge Description Master (CDM) Review 

Over the past year, the Commonwealth of Virginia has expanded Medicaid and passed HB1700, increased reimbursement for Virginia CAHs in July 2019. In order to ensure the Virginia CAHs are foundationally set to maximize their financial performance, they will participate in the Strategic Pricing Program, which will provide hospitals a comprehensive review of their respective CDM.  Hospitals will be able to use the secure web-based portal and applications to update charge levels based on quarterly updates from the American Medical Association (AMA) to maintain defensible, market-driven prices for new and existing service lines and procedures.

Medicare Cost Report Analysis

This activity was developed to help Virginia CAH chief Financial Officers (CFOs) minimize errors in their Medicare Cost Reports and adopt accounting principles that optimize reimbursement consistent with the Centers for Medicare and Medicaid Services' (CMS) rules and regulations. Six of the seven Virginia CAHs have merged with larger urban-based health systems that provide centralized administration, including financial and operational oversight. To ensure the cost report is done with a rural lens, the Virginia Flex Program will provide this activity as a platform to identify an initial portfolio of financial improvement opportunities and needed resources.

Concluding each program year, they survey and reach out to their CAHs for constructive feedback and initiate a process improvement lens to our activities. 

CAH Population Health Improvement

Population Health 101 Webinar and Population Health Strategic Planning

The term population health has been used as a nebulous idiom. When most health systems discuss population health, Virginia has noticed they are speaking to how to manage diabetes better. In Virginia, their goal for addressing population health is to go further upstream and understand root causes, such as the societal factors causing the high rate of diabetes. Fiscal Year (FY) 19 will be used as a planning year, to establish the Flex Program’s initiative for the next four programmatic years.

Although many community-specific needs are identified in their hospitals' community health needs assessments (CHNAs), in order to sustain and achieve healthier communities, they must understand the underlying socio-economic determinants and address root causes. There will be an attempt for programmatic alignment with the Commonwealth’s state-wide Healthy Virginia initiative, but the Flex Program’s priority is to support CAH community-level activities and provide targeted resources that align with their identified needs. 

Rural Emergency Medical Services (EMS) Improvement

CAH & Regional EMS Site Visits, Assessment & Findings

The Virginia Flex Program and the Virginia Office of EMS, Community Health and Technical Resources (CHaTR) division will collaborate to: 

  • Conduct a pre-visit review of previously completed assessments and recommendations
  • Conduct formal interviews with various stakeholders of the EMS System in the CAH-specific county, as well as the CAH County 911 Coordinator
  • Concuct formal interviews with CAH staff, including the Chief Executive Officer (CEO) and Emergency Department Clinical Coordinator
  • Conduct formal interviews  ith local EMS agencies

These interviews will be held to gather information regarding the relationship between the CAH and the EMS System, and vice versa, as well as to determine the capabilities of both. After the site visit, the Office of EMS CHaTR division will provide the CAHs & EMS system leaders with a report of findings, recommendations, and follow-up action planning.

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

The Virginia Flex Program's network activities include:

  • Rural Hospital Coaching Collaborative
  • Partnership for a Healthy Virginia
  • Virginia Rural Hospital Association
  • Rural Center for Virginia

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

FY 19, the Flex Program is reaching out and exploring potential relationships and collaborative activities that will not only provide guidance toward value-based purchasing (VBP), but also provide opportunities to address socio-economic root causes that lead to poor health outcomes.

Federal Reserve Bank of Richmond & CDFIs

  • Community development financial institutions (CDFIs) are private financial institutions that are 100% dedicated to delivering responsible, affordable lending to help low-income, low-wealth, and other disadvantaged people and communities join the economic mainstream

Social Finance

  • Exploring Pay for Success-type projects, Outcomes-based scorecards and risk-based contracting for our rural facilities
  • Virginia Department of Medical Assistance Services

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1.0
Website None Provided
Number of CAHs 7

Flex Program Staff

Heather Anderson
Director, Division of Primary Care and Rural Health, Virginia
(804) 864-7426

Director, Division of Primary Care and Rural Health since September 2015

Clarissa Noble
Rural Health Manager, Virginia
(804) 864-7433

Flex Coordinator since May 2018

Sarah O'Connor
SORH Coordinator, Virginia
(804) 864-7420

 SORH Coordinator since March 2020.

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, $1,009,121 (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.