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University of Wisconsin

Top Flex Activities

CAH Quality Improvement

The Wisconsin Office of Rural Health (WORH) is working with a contractor to offer the Sepsis Tracking and Improvement project. The project promotes early detection and intervention in cases of suspected sepsis using Centers for Medicare and Medicaid Services (CMS) sepsis bundle measures with an expected outcome of reduced harm from sepsis. Recruiting hospitals to participate proved to be the greatest challenge, not because of a lack of interest, but responding to the COVID-19 pandemic left hospitals without time and resources to commit to other projects. Hospitals that were able to participate received a web-based data collection tool, individualized reports, education, and consulting. Impacts will be assessed at the end of the grant year.

WORH is working with a contractor to help critical access hospitals (CAHs) to improve antibiotic stewardship, specifically by assessing and reducing Fluoroquinolone use.  The contractor has engaged five CAHs in the project.  They conduct on-site assessments, working to understand how antibiotic prescribing decisions are made within each facility and the “checks and balances” that are currently in place.  They identify high risk and failure points when Fluoroquinolone prescriptions may not meet standards for appropriate use.  The contractor produces a report of findings along with resources and recommendations for each hospital.  

CAH Operational and Financial Improvement

WORH has provided funding for two CAHs and their financial improvement projects, including one that has engaged a consulting firm to lead revenue cycle optimization and one that has installed software to stay compliant with price transparency.  Our office holds an annual Rural Hospital Finance Workshop, which has been on hold since the start of the pandemic.  We hope to be able to resume the Workshop in the Fall of 2022.

CAH Population Health Improvement (optional, report if you have included in your work plan)

WORH has several population health improvement projects. The Flex Program is funding three CAH obesity reduction projects over a four-year period. Additionally, WORH is also providing funding to one hospital and their community partners to plan and implement programming targeting substance abuse.

Rural Emergency Medical Services (EMS) Improvement (optional, report if you have included in your work plan)

WORH is holding EMS service director trainings throughout the state. Normally held in-person, they have temporarily moved to a virtual format. If anything, the formatting change seems to have increased interest as we have had higher attendance and many participants calling in from beyond our state borders.

WORH is working with an expert in the EMS field on the Time Critical Diagnosis (TCD) Patient Management Improvement Project. The contractor meets several times in person with the service director and other crew members, reviewing protocols and policies, making recommendations for changes, and helping to develop implementation plans and benchmarks.  Due to the pandemic, enrollment has slowed, but we are hoping recruitment will strengthen in the upcoming months.

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

Wisconsin has several networks of CAHs that are engaged in a variety of quality improvement topics and efforts.  These include stroke, sepsis care, antibiotic stewardship, swing beds and coronary artery disease. In addition, Wisconsin has a strong network of stakeholder organizations with a committed interest in Critical Access Hospitals, small rural hospitals, and rural healthcare in general.  Our office works closely with the Hospital Association, the Rural Wisconsin Health Cooperative, MetaStar (QIO), and others to prevent duplication of efforts and provision of improvement initiatives of the highest value for Wisconsin’s CAHs and rural hospitals.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization University
Staffing (FTE) 3.4
Website Organization Website 
Number of CAHs 58

Flex Program Staff

John Eich
State Office Director, Wisconsin
(608) 261-1890

Specialty Areas / Background

  • Strategic planning
  • Marketing
  • Evaluation

State Office Director since January 2006 

Kathryn Miller
Flex Coordinator, Wisconsin
(608) 261-1891

Specialty Areas / Background

  • Grant writing
  • Long-term care
  • Conference planning

Flex Coordinator since September 2008 

Penny Black
Data and Evaluation Program Manager, Wisconsin
(608) 261-1887

Data and Evaluation Program Manager


Data and Evaluation Program Manager since July 2014

Kevin Jacobson
Rural Communities Program Manager, Wisconsin
(608) 261-1888

Specialty Areas / Background

  • Grant writing
  • Community health
  • Loan assistance programs

Rural Communities Program Manager since April 2007 

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, $1,560,000 (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.