Rural Route
June, 2020
In this Issue
TASC Updates
Webinars & Events
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Resource Library


State Flex Profiles




Rural Health Value


Hello everyone,

I hope you are all having great starts to your summer! 

This month's Rural Route is filled with multiple new resources, critical access hospital (CAH) recognitions, and new opportunities including a new CAH recognition announcement . We really appreciate you taking the time to read this newsletter.
We also love to see Flex colleagues using 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
Technical Assistance and Services Center (TASC)

Federal Office of Rural Health Policy (FORHP) Updates   
by  Tori Leach
I enjoyed virtually connecting with some of you over the National Rural Health Association's (NRHA) Virtual Annual Meeting. As we move into virtual meetings throughout the summer, I know we are learning from missteps and drawing on best practices to ensure that our virtual meetings continue to get better, and encourage more connection and networking opportunities.

Natalia and I were very impressed, reading through your Flex Non-Competing Continuation (NCC) Progress Reports, by all of the work you have continued to do to support your rural stakeholders during these challenging times. We applaud your innovation and ability to be adaptable and flexible in altering your work plans to ensure that you are addressing the changing needs of your hospitals and communities. For states that requested to submit the  NCC Progress Reports through the Request for Information (RFI) process, please submit by July 15, 2020, in the Electronic Handbook (EHB).

FORHP has a  COVID-19 webpage to provide information about resources and funding sources that are specific to addressing the public health emergency in rural areas.

On Thursday, June 25th at 3 p.m. Eastern Time, FORHP will host a  Poolside Chat: Invitation to Discuss Strategies for a Medicare Beneficiary Quality Improvement Project (MBQIP) Refresh for all State Flex Programs. 

I would also like to draw your attention to the recently released Flex Monitoring Team (FMT) brief on  Engaging Critical Access Hospitals in Addressing Rural Substance Use.
CAH Regulatory Update

Continue reading CAH Regulatory Updates (Flex Forum login required - contact TASC for details)

Please help us welcome  Lindsay Konen the new Flex Program Specialist in Montana! Welcome Lindsay!

We also bid a fond farewell to  Sherry Johnson  of Arkansas.  We wish you well, Sherry!
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
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 (Upcoming newsletter)
  • Mason District Hospital -- Havana, Illinois (Spotlighted in this newsletter)
  • Ste. Genevieve County Memorial Hospital -- Genevieve, Missouri (Spotlighted in this newsletter)
Mason District Hospital (MDH) built their care coordination program from the ground up. When the Care Coordinator at MDH accepted her position, there was not a care coordination program in place. This worked to their advantage by allowing them to align their initial areas of focus with the patient-centered goals promoted by their Accountable Care Organization (ACO). MDH joined the Illinois Rural Community Care Organization (IRCCO)--an ACO who provided them a playbook that laid out a framework of best practices that could be implemented to increase care coordination while reducing the overall patient spend for attributed Medicare patients.

MDH hardwired basic quality initiatives such as promoting Medicare Wellness Visits before adding additional levels of care coordination. A few months later they introduced full care coordination to all providers practicing in their three rural health clinics. "As providers began to realize the benefits of care coordination, the number of participating patients grew", said Doug Koiser, Mason District Hospital CEO.  

Doug Kosier, CEO , Mason District Hospital, and Amy Ewalt, Care Coordinator, proudly accept the National Rural Health Resource Center's Certificate of Recognition for demonstrating excellence and innovation in care coordination initiatives.

Positive Outcomes
  • Patient participation in the care coordination program grew from three patients at the end of 2018 to over 132 patients at the start of 2020.
  • HbA1c levels have been successfully lowered by providing education and medication management via care coordination for diabetic patients. 
  • Depression screening quality score improved for on MDH clinic, from 2.9% in 2018 to 67.3% in 2019.
Top Accomplishments

"We're honored to have received this national recognition for our care coordination efforts. We've put a lot of work into implementing a chronic care management program to offer to patients within our rural health clinics," said Doug Kosier, Mason District Hospital CEO. Doug shared that the CCM program was developed with guidance from ICAHN's 12-week development course in 2018. "Now that it has grown, our providers are beginning to see the difference in the care of their patients who are enrolled. One of them recently said he is 'thrilled with his patients in the program and is more up-to-date with their care than he has ever been' in reference to specialist referral tracking.  CCM puts the patient at the center of their care by providing them a personalized care plan to share with all of their providers and caretakers." 
Ste. Genevieve County Memorial Hospital (SGCMH) has a swing bed hospital-based program for Transitional Care (skilled nursing). Recently, SGCMH implemented an innovative care model, standardized triage process, and collaboration with select tertiary care centers to transition patients into a short-term skilled nursing program. The Transitional Care goal is to address needs of patients who are being discharged from acute care but are not ready or safe to go home. As a traditional skilled nursing facility (SNF) alternative, Transitional Care patients benefit from low nurse-to-patient ratios, and receive interventions typically seen in acute care including daily physician rounding, intravenous antibiotics (IVAB), IV medications, wound care, physical and occupational therapy (PT/OT), and palliative care. Differing from nursing home, SNF are the 24 hour per day availability of lab, radiology, and respiratory therapy.

Hirshell Parker, Executive Director of Quality & Risk Management, said, "We identified a need in our community that led us to further develop our Transitional Care/Swing bed program, which allows us to get patients back home in a safe and timely manner. By doing so, we have improved the quality of care for patients and reduced hospital readmissions."

Right to Left: Hirshell Parker, Katie Hogenmiller, Brandie Filer, Tom Keim, Dr. Noguera, Morgan Ritter, Anna Mattingly, Rita Brumfield, Kim Lalumandier

Positive Outcomes
  • In the past 12 months, only 6% of patients placed in their Swing bed program have been subject to readmission compared to the SNF state average of greater than 21%.
  • Over 75% of patients return home in a reduced length of time. Depending on individual needs, patients are generally able to discharge in less than 10 days, compared to 21 days or more in a traditional SNF. 
  • In June 2018, SGCMH began tracking the volume of external referrals on their scorecards. Since the implementation of this internal metric, they have effectively transitioned over 180 patients from external facilities. This number does not include patients transitioned to Swing bed from admissions located within their organization.
Top Accomplishments

A TeamSTEPPS-based daily multidisciplinary team huddle develops a shared mental model. This helps identify care needs of each patient allowing transition back to the prior level of functioning. A quantitative admission high-risk screen was developed and is performed on each patient to identify readmission risk. High-risk determination triggers in house referrals and includes additional discharge community resources. Patients have a choice, but external case management teams are engaged on an ongoing basis to transition patients based upon skilled need and acuity. Decreased readmissions reduce costs. Finally, follow up calls are made within 48 hours of Transitional Care discharge to assess understanding of medications, discharge care, and ensure a primary care visit 3-5 days of discharge.

"Ste. Genevieve County Memorial Hospital is a valuable asset to the health care system," Sara Davenport, Chief, from the Missouri Office of Rural Health and Primary Care said. "Through their excellent work, patients are receiving quality care close to home."

Tom Keim, Chief Executive Officer, said, "We feel we provide real value to our patients and those of larger acute care hospitals to help transition patient care, reducing readmissions by offering a service that allows care to be flexed to meet the needs of each individual patient."
TASCUpdatesTASC Updates
New CAH Recognition Nominations: Post-Acute Care  
Do you know of a critical access hospital (CAH) that has implemented an innovative approach to Post-Acute Care , that supports a patient's continued recovery from illness or management of a chronic illness or disability?  If so, please consider nominating them for  CAH Hospital Recogniton an initiative of the TASC and FORHP. 
The purpose of the CAH  Recognition  initiative is to capture best practices and recognize the innovative work being done in CAHs across the country.  It is also an opportunity for state Flex Coordinators to highlight the support state Flex Programs are providing to CAHs. Examples of CAH recognitioncan been above and on the TASC website
Based on the scoring criteria listed below, chosen CAHs will each receive a Certificate of Recognition.  They will also be profiled in this newsletterbe profiled on the TASC website, as well as be promoted via The Center's social media platforms.  Please visit TASC's website to see past  CAH Recognition Awardee Spotlights .  A press release template will also be sent to the CAH to promote their recognition to communities in their service area. 
Typically, we encourage Flex Programs to present certificates of recognition in person, however, due to COVID-19 we understand that may not be possible.  Please use your best judgement and follow the CDC and your state's guidelines regarding in-person events.  If you are unable to present in person, you can simply mail the certificate to the CAH.  Whether the certificate is presented in person on mailed, we ask that the state Flex Program reaches out to the CAH Administrator/CEO to get a quote, as well as ask for a couple pictures of the facility, staff, or of an internal event, and send to Andy Naslund at  for the promotional purposes listed above.  
CAH Post-Acute Care initiatives must meet the following requirements:  
  • Was supported by the state Flex Program 
  • Has a well-developed evaluation plan 
  • Able to share 2-5 qualitative and/or quantitative outcomes 
Thorough descriptions of the following are required:  
  • Innovative approach to post-acute care implemented to improve population health. 
    (0-3 points) 
  • How implementing the CAH's approach to post-acute care was identified as a need.  
    (0-2 points) 
  • Two to five qualitative and/or quantitative outcomes that explain how the initiative is successfully meeting community needs and improving population health.  
    (0-5 points) 
  • How the state Flex Program supported the CAH in their post-acute care implementation efforts. (0-2 points) 
Nominations will be accepted through  Friday, July 10, 2020 Please submit your CAH Recognition nominations  here .
New SRHT Podcast Series! Managing from the Middle: Leading Through Change
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. New episodes will be available every Tuesday through July 28, 2020.

In this inaugural episode, listeners will begin to understand the transition to value-based care and population health and why mid-level management plays a critical role. Joining the conversation are Kyle Southerland, Special Projects and Community Health Coordinator with Bacon County Hospital in Georgia and Terry Hill, Senior Advisor for Rural Health Leadership and Policy at the The Center.

New! Community Paramedicine Impact Reference Guide 
The  Community Paramedicine Impact Reference Guide is a resource for those intending to research, plan, implement, evaluate, or otherwise consider community paramedicine (CP) systems. This resource includes a compilation of cited references that describe the impact of previously implemented CP initiatives. Those considering CP systems can review results as applicable to their initiative and use the information to inform implementation. References include both the impact that CP has, the potential to have, or has been demonstrated to have on patients, health care systems, payers, health care provider organizations, health care practitioners, and others. It also reflects the impact that policy and health, and medical practices have the potential or have been demonstrated to have on CP and its stakeholders.

EMS Collection of Resources
Currently, the health care industry is undergoing profound change, moving away from dependency on fees assessed for the volume of services provided and toward a people-centered, value-based operation that rewards positive patient outcomes. Transformation to the next evolutionary stage is necessary if EMS is to thrive and play an integral part in the changing health care system. This  collection of key EMS resources is intended to help rural EMS adapt and become a more integrated part of the evolving health care system
Please send your MBQIP questions to TASC will ensure your question reaches the appropriate person.
Updated CAH Finance Resources
TASC, in coordination with FORHP, are pleased to announce the annual update of the  Critical Access Hospital Finance 101 Manual, and the  Critical Access Hospital 2012 Financial Leadership Summit Summary. Both documents have been updated with 2018 US Critical Access Hospital (CAH) medians that can be used by your state Flex Program, CAHs, and other rural stakeholders as a gauge for progress and comparison. As a reminder, there is also valuable, and more detailed comparative data available to all state Flex Programs and individual CAHs via the  Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS). 

For more information on CAHMPAS and how to use this tool, the  CAHMPAS Support resource page is a great place to start and includes guides, tutorials, definitions, and frequently asked questions.
Webinars, Recordings & Events
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 bridging the divide between behavioral health and physical health, the transformation of care, the importance of the relationship between the hospital board and the hospital CEO, and pharmacists and their role in delivering healthcare in rural America. 

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