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Wyoming Department of Health

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CAH Quality Improvement

The Medicare Beneficiary Quality Improvement Programs (MBQIP) core measures are patient safety, patient engagement, care transitions, inpatient and outpatient measures. The Wyoming Flex Program's most significant accomplishment in FY2020 was in patient safety. A concern for public health is antibiotic resistance. Bacteria and fungi germs become resistant to antibiotics, increasing deaths. CAH's annually submit to the National Healthcare Safety Network (NHSN) responses to seven core antibiotic stewardship program (ASP) elements. In 2019, Wyoming had thirteen CAHs reporting to NHSN. That number increased to fifteen in 2020. The Flex Program continues to provide technical assistance to the one remaining CAH

Rural Health Solutions facilitated four ASP roundtables with 52 staff and nine CAHs represented. During one of the roundtables, RQITA presented the Flex Program's raw data for the first time. Previously the data reflected whether or not the CAH was meeting the minimum on each core measure. The Flex Program dedicated the remaining ASP roundtables to identifying the lowest-scoring measures and improving resources. The NHSN ASP data is reported annually at the first of the year. The Flex Program receives the data three to six months after the reporting period. The Flex Program monitors this activity to measure improvement in awareness and knowledge.

Increasing awareness around the public health concern for antibiotic resistance continues. The COVID-19 public health emergency is at the forefront of the work of infection prevention specialists. However, reducing healthcare-acquired infections remains a priority and is addressed through ASP. The lesson is that although there is a public health emergency, it is essential to minimize antibiotic resistance. 

The best practice is to promote the U.S. antibiotic awareness week through the Centers for Disease Control and Prevention (CDC). The site and resources are shared with the CAHs by the Flex Program. The resources include a Partner Toolkit, Get Involved and Related Programs. The Partner Toolkit includes messages about antibiotic resistance and social media posts, graphics, videos, handouts, and posters. CAHs that share this information help spread awareness by educating the public about this public health concern.

An activity funded through FY19 Flex Program carry-over during the FY20 project period was Mental Health First Aid (MHFA) instructor training. The Flex Program identified one person from a CAH and one community prevention specialist from each county to train.

CAH Operational and Financial Improvement

Wyoming collects financial productivity indicators from the CAHs that submit data into Quality Health Indicators (QHi). The reporting and analysis of the Flex Programs financial productivity indicators is a data-driven decision-making tool to identify CAHs for financial improvement activities. The COVID-19 public health emergency shifted focus from sustainability to stability. Two COVID FI roundtables kept the CAHs informed on federal changes to financial reporting.  

For the Flex Program federal fiscal year 2020, the most significant operational and financial achievement is in the FI roundtables, education, training, and professional development. In the FI roundtables for Flex Program fiscal year 2020, Rural Health Solutions facilitated two COVID finance roundtables, one revenue cycle management, and Stroudwater Associates presented on the financial benefit of the swing bed service line.

Reimbursement scholarships for financial improvement benefit CAH staff training and hospital stability. The training and professional development CAH staff attended include America Health Information Management Association, Grant Writing USA, NOSORH Grant Writing, coding and billing, Lean Training, and Medicare Boot Camp. This increase in staff knowledge benefits the CAH's financial stability through having a well-trained and educated staff.

CAH Population Health Improvement

The Wyoming Flex Program work plan lists the following activities for population health: identify community and resources, build strategies to prioritize and address unmet needs of the community, and engage with community stakeholders and public health experts to address specific health needs. Several CAH staff attended different certification and training programs, including Sugar, Temperature, Airway, Blood Pressure, Lab work, and Emotional support (S.T.A.B.L.E) infant stabilization, falls workshop, Certified Dementia Care and Grief Counseling, and National Restaurant Association show.

Rural Emergency Medical Services (EMS) Improvement

The WY Flex Program's significant accomplishment for 2020 in EMS is the reimbursement scholarships rural emergency medical technicians (EMT) utilized. The Flex Program reimbursed for the following training and certification: Cardiopulmonary Resuscitation (CPR) for Kids and Paramedic Refresher, Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), Healthcare Administration, and Critical Care Paramedic training. One EMS Agency held an ACLS Course with five participants.

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

Collaboration between the Wyoming Flex Coordinator, Quality Reporting Services (QRS), and Rural Health Solutions (RHS) contributes to the success of the Flex Program. The Wyoming Hospital Association (WHA), Mountain-Pacific Quality Health (Quality Improvement Organization), Wyoming Healthcare Financial Management Association (HFMA), Wyoming Primary Care Office (WYPCO), and Wyoming Department of Health (WDH) Public Health Division (PHD) are available to support CAHs improvement efforts. Population health and EMS improvement activities benefit from cooperation with the Rural and Frontier Health Unit (RFHU), Office of Rural Health (ORH), Office of Emergency Medical Services (OEMS), Healthcare Acquired Infection (HAI) surveillance, Chronic Disease Prevention Program, and the Office of Health Equity (OHE). Support from the HRSA Flex Coordinator, the National Rural Health Resource Center, the National Organization of State Office of Rural Health (NOSORH), and the Federal Office of Rural Health Policy (FORHP) preserve the integrity of the program by offering resources and sharing knowledge.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Yes
Type of Organization State Government
Staffing (FTE) 1
Website Organization Website
Number of CAHs 16

Flex Program Staff

Sharon Weber
State Office Director, Wyoming
(307) 777-7293

State Office Director since December 2021

Kyle Cameron, MPhil., M.S.
Flex Coordinator, Wyoming
(307) 777-8902

Specialty Areas / Background

Kyle has a master's degree in organizational leadership including human resource management, change theory, business, policy, procedures, systems and social science. Her previous work experience includes the Rural and Frontier Health unit of the Wyoming Public Health Division, Laramie County Community College as adjunct staff and human resource specialist at Community Action of Laramie County.

Flex Coordinator since October 2016

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.