Rural Route
 
July, 2020
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Hello everyone,

I hope you are all in the middle of great summers! 

We are so excited to see everyone virtually at the 2020 Flex Program Virtual Reverse Site Visit (RSV)  next week on August 4th-6th. The agenda for the conference is available on the Technical Assistance and Services Center (TASC) website , but please let me know what questions you have regarding the conference 

This month's edition of Rural Route includes more information about the RSV, a hospital spotlight of Lincoln County Medical Center in Ruidoso, New Mexico, and new resources like the COVID-19 Funding Sources Impacting Rural Providers guide. We appreciate you taking the time to read this newsletter.
 
Also, please continue to use the Flex Forum as a means for networking with your peers, a place for Q&A, and participation in meaningful discussions. I f you have questions or need assistance regarding the Flex Forum, or anything else, please reach out to  me  or  TASC .


Best ,
                              
Andy Naslund
Program Coordinator
TASC
             

Federal Office of Rural Health Policy (FORHP) Updates   
by  Tori Leach
Thank you all for submitting your Flex Non-Competing Continuation (NCC) Progress Reports, Natalia and I were very impressed to read about your continued efforts in the Flex Program and how many of you have adjusted your work plans to incorporate COVID-19 initiatives.
I am excited to announce that we have a new addition to the FORHP Hospital State Division! Laura Seifert will be a Project Officer for the Flex team as well as the Program Coordinator of the Flex Monitoring Team. Laura holds a Master's Degree in Public Health from the University of New England, as well as a Master's of Arts in Bioethics from Kansas City University of Medicine and Biosciences.  Laura, a former Peace Corps member, comes to Health Resources and Services Administration (HRSA) after serving in Ancash, Peru, as a Public Health Educator with extensive experience providing health outreach activities in low resource environments. Read more about Laura's extensive background at the my full update here.
At the Flex Virtual Reverse Site Visit (RSV) next week, I am looking forward to introducing you to the new FORHP  Flex Team. I will also be sharing the new map of Project Officer assignments that will be in place as we move into Year 2 of the Flex Program. 
CAH Regulatory Update
Continue reading CAH Regulatory Updates  (Flex Forum login required - contact  TASC  for details)
Please help us welcome Dorothy Marcello, Senior Health Planner, of New York and Kaitlin Thomas, Administrator, of South Dakota Welcome to you both!

We also bid a fond farewell to Andy Klitzke  of South Dakota.  We wish you well, Andy!
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Please keep your Flex staff contact information current by completing the  State Flex Program Contact Information Form  whenever there are staffing changes in your office. 
CAH Recognition Spotlights! Innovative Care Coordination Initiatives to Improve Population Health
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Critical Access Hospital Recognition was established by The Center and FORHP to recognize the excellent work in Critical Access Hospitals (CAHs) and other rural safety net providers throughout the country. In this round of CAH Recognition, these four hospitals received national recognition for demonstrating innovative care coordination initiatives to improve population health:
  • Lexington Regional Health Center -- Lexington, Nebraska (Upcoming newsletter)
  • Lincoln County Medical Center -- Ruidoso, New Mexico (Spotlighted in this newsletter)
  • Mason District Hospital -- Havana, Illinois (Spotlighted in the June newsletter)
  • Ste. Genevieve County Memorial Hospital -- Genevieve, Missouri (Spotlighted in the June newsletter)
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Lincoln County Medical Center (LCMC) , located in Ruidoso, New Mexico, was one of only four critical access hospitals (CAHs)  that earned national recognition for demonstrating innovative care coordination initiatives to improve population health.
LCMC has a data-driven project that has dramatically reduced hospital readmissions among Medicare patients. The hospital identified a need to reduce admission rates through their review of regulatory and health improvement organization literature on readmissions, their strategic goals, readmission data, and risk stratification. As part of the project, teams took a deep dive into the drivers of high utilization and adjusted programs to better serve patients.
One of the primary approaches to improving care coordination and reducing hospital readmissions was increasing the presence of case management in the emergency department (ED). Case managers regularly meet with the patients and their families in the ED to take a holistic approach as to why they are in the hospital or perhaps have returned to the hospital. The hospital also implemented a new patient and family questionnaire that was given to patients who have been in the hospital multiple times throughout the year. This questionnaire was modified to gain a better perspective of why the patient and his/her family members believed they were back in the hospital. Lastly, the third major approach to support care coordination and reduce hospital readmissions was the implementation of home visits by emergency medical services (EMS). The hospital developed a process for EMS to visit the patients once they transitioned home.
Positive Outcomes
  • The hospital readmission rate for patients 65 years & older began at 6.5% in 2017, which was below their organization's goal of 5.2%. Through the approaches identified above, the hospital reduced readmissions to 1.3%.
  • As a result of the project, LCMC was also named a Quest for Excellence Award winner and Top Hospital for 2019 by the New Mexico Hospital Association.
Top Accomplishments
Increasing the number of case managers in the ED provided an opportunity for them to facilitate interventions or set up services that will support the patient such as home health services or outpatient counseling. Utilizing the patient and family questionnaire helped the clinical team gain an entirely new perspective on the various reasons for a particular hospital readmission. It also aided in facilitating the proper interventions and services that were put into place at the time of discharge. Finally, implementing EMS home visits helped facilitate communication and coordination with the patient and their families to ensure they had the resources and support they needed to be safe and healthy at home.
"I am incredibly proud of our team for their work on this project," said Todd Oberheu, hospital chief executive. "With this project, they used data to take a close look at the reasons some patients ended up returning to the hospital and took important steps to address them. This is a great example of LCMC's focus on improving the health of our community."
TASCUpdates
TASC Updates
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The 2020 Flex Program Virtual Reverse Site Visit (RSV) will take place next week on August 4th-6th. The RSV will be live starting August 4th at 11:00 a.m. Central Time, and it will include two keynotes on health equity and leadership, a Federal Rural Health Policy and Regulatory Panel session, 12 breakout sessions, two small group discussion sessions, and multiple sessions from FORHP. All sessions will be recorded, but please note that you will have needed to register to view the RSV content. If you have any questions, please reach out to Andy Naslund.

Creating 20/20 Vision: Empowering Flexibility in Rural
The focus of the Federal Office of Rural Health Policy's ( FORHP ) 2020 Flex Program Reverse Site Visit (RSV) is the importance of flexibility and adaptability in today's rapidly changing health care environment. The purpose of this event is to provide state Medicare Rural Hospital Flexibility (Flex) Programs with a collaborative learning environment to make connections, share best practices, and gather lessons learned to empower and support state Flex Program and CAH  flexibility. Through content and discussions, participants will be able to create clarity, or a 20/20 vision, for improving and strengthening rural health care. We look forward to your participation at this educational and informative virtual event.
Flex Program RSV Learning Objectives
Upon conclusion of the Flex Program RSV, participants will be able to:
New SRHT Podcast Series! Managing from the Middle: Leading Through Change
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With the support of the Federal Office of Rural Health Policy, Managing from the Middle: Leading Through Change, a six-part podcast series was developed by the  Small Rural Hospital Transition Project  for rural hospital mid-level management. Listen to all six episodes here.
Please send your MBQIP questions to tasc@ruralcenter.org. TASC will ensure your question reaches the appropriate person.
Webinars, Recordings & Events
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Rural Health Leadership Radio  was launched to support rural health leaders in sharing stories and information about best practices and lessons learned. Check out their latest podcasts now! 

The most recent interview topics include an educational opportunity for nurses and the perils of working in agriculture, providing culturally relevant care, caregiver heroes and the impact of kindness, and how health care is a core function of the community and how it defines that community.



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