WYOMING FLEX PROGRAM PLANNING 2014-2015

4/9/2014

Flex Program Planning Meeting Summary Wyoming State Office of Rural Health Wyoming Hospital Association Wyoming Critical Access Hospital Network Wyoming Office of Emergency Medical Services Mountain-Pacific Quality Health Rural Health Solutions

Wyoming Flex Program Planning 2014-2015

Wyoming Flex Program Planning 2014-2015 F L E X P R O G R A M P L A N N I N G M E E T I N G S U M M A RY

SUMMARY The Wyoming Medicare Rural Hospital Flexibility (Flex) Program conducted a program planning meeting on April 9, 2014. The meeting was an opportunity to: 1) discuss on-going and new challenges facing Flex Program stakeholders, in particular Critical Access Hospitals (CAHs) and local emergency medical services (EMS); 2) update stakeholders on state and federal program changes; 3) review, discuss, and make changes to state Flex Program objectives and activities; 4) offer networking opportunities between all stakeholders; and 5) further align and identify opportunities for the Flex Program; Wyoming Critical Access Hospital Network (WCAHN); Wyoming Department of Health, Office of Rural Health (ORH) and Office of Emergency Medical Services (EMS); Wyoming Hospital Association; and Mountain-Pacific Quality Health to leverage their resources to better meet the quality and performance needs of CAHs and rural EMS. There were 15 meeting participants representing 11 stakeholder organizations. The meeting included the following agenda items: 1) Wyoming state updates; 2) Mountain-Pacific Quality Health (state’s Quality Improvement Organization – QIO) updates; 3) federal Flex Program updates; 4) review of CAH quality improvement activities and state data, as well as reports from each participating CAH including needs and recommended program next steps; 5) review of CAH performance and financial improvement activities and state data, as well as reports from each participating CAH, including needs and recommended program next steps; and 6) review of health systems development, trauma, and EMS activities, as well as reports from participating CAHs and the State Office of EMS, including needs and recommended next steps. While it was determined that some planned Flex Program activities should continue through 2014, program adjustments and new activities are incorporated into the 2014-2015 Flex Program work plan. MEETING PARTICIPANTS There were 15 meeting participants representing CAHs and other state Flex Program stakeholders, including:  Maureen Cadwell, Weston County Health Services, Newcastle  Rick Schroeder, North Big Horn Hospital, Lovell  Robin Roling, Hot Springs County Memorial Hospital, Thermopolis  Ryan Smith, Memorial Hospital of Converse County, Douglas  Eric Boley, South Lincoln Medical Center, Kemmerer  Jannette Vanbeek, Crook County Medical Services, Sundance

Page 1

Wyoming Flex Program Planning 2014-2015

         

Sharla Allen, Wyoming Department of Health, Public Health Division, Office of Rural Health Michelle Hoffman, Wyoming Department of Health, Public Health Division, Office of Rural Health Laura Hurst, Wyoming Department of Health, Public Health Division, Rural and Frontier Health Brandon Kelley, Wyoming Department of Health, Office of EMS Steve Bahmer, Wyoming Critical Access Hospital Network Neil Hilton, Vice President, Wyoming Hospital Association Deb Fleming, Mountain-Pacific Quality Health Shanelle VanDyke, Mountain-Pacific Quality Health Belinda Willson, Mountain-Pacific Quality Health Rochelle Schultz Spinarski, Rural Health Solutions (facilitator)

FLEX PROGRAM REVIEW The Flex Program is currently in Year-4 of a five-year grant cycle. The program continues to include the following priorities: 1) quality improvement, 2) performance/financial improvement, 3) health systems development and community engagement, and 4) CAH conversion. In addition, the Health Resources and Services Administration (HRSA), Office of Rural Health Policy has directed all state Flex Programs to collect and report evaluation measures reflecting program outcomes. FLEX PROGRAM OBJECTIVES The Wyoming Flex Program focuses on three of the four federal priorities and the following objectives:1        

Sign up and actively report Phase 1, 2 and 3 measures of the Flex Medicare Beneficiary Quality Improvement Project (MBQIP). Encourage CAHs to publicly report data to Hospital Compare (participation is defined as submitting data on at least one inpatient measure). Support CAH participation in quality reporting and benchmarking initiatives other than Hospital Compare (e.g., state and multi-state CAH quality networks). Support CAH participation in a multi-state quality improvement (QI) project. Support CAHs in planning and implementing evidenced-based strategies for improving financial performance. Support CAHs in planning and implementing evidenced-based strategies for improving operational performance. Support the inclusion of EMS into local and/or regional systems of care and/or regional and state trauma systems. Support the sustainability and viability of rural EMS.

QUALITY IMPROVEMENT The Wyoming Flex Program is meeting its quality improvement related federal objectives through participating in Quality Health Indicators (QHi) and MBQIP, providing quality improvement technical assistance to CAHs, reporting findings and sharing Flex Monitoring Team best practices, supporting CAH travel to quality improvement training opportunities and workshops, partnering with Mountain-Pacific Quality Health, and engaging CAH staff in QI planning activities. When asked about current quality improvement 1

No rural hospital in Wyoming is currently considering or pursuing CAH designation.

Page 2

Wyoming Flex Program Planning 2014-2015

activities and priorities, CAH leadership report the following: 

      

Advancing patient safety initiatives, including: o Just Culture o Staff training o Identifying best practices o Developing (samples) and implementing action plans, data use o Direct technical assistance through quality coaches o Physician engagement Quality coaches for more specialized and in-depth technical assistance QI hospital rounds Behavioral health pilot project Quality collaborative QI best practices showcase HCAHPS improvement training and technical assistance QI training support for hospital boards that are just learning about QI and its significance

After further discussion of these current QI priorities, CAH leadership agreed on the following 2014-2015 priorities for investment in Flex Program resources: establishing a patient safety project, supporting the use of on-site quality coaches, and support for a behavioral health planning pilot. There was a lengthy discussion about the lack of behavioral health services in rural Wyoming and its impact on population health and health systems development. All partners agreed this should be a priority area moving forward and additional stakeholders should be engaged in pilot planning efforts. PERFORMANCE AND FINANCIAL IMPROVEMENT The Wyoming Flex Program is meeting its performance improvement related federal objectives through participating in QHi, offering CAH Executive Leadership Training; supporting CAH travel to performance and financial improvement conferences and meetings; supporting Studer implementation in CAHs; providing billing, coding, and collections assessments; financial workshops; access to the WCAHN, and training and technical assistance. When asked about current financial and operational improvement activities and priorities, CAH leadership report the following:          

Board/Trustee education ICD-10 training Resources to attend workshops and conferences Financial and operational assessments Lean training and implementation support Support for a WCAHN chief financial officer group Tools for establishing accountability within departments New models and definitions for hospital operating with declines in hospital utilization, in particular emergency room and inpatient services Resources to support grant writing and knowledge of the funding that is available Charge master review

Page 3

Wyoming Flex Program Planning 2014-2015

When asked to prioritize these needs and identify where the Wyoming Flex Program should focus its resources in FY14, CAH leadership agreed upon: support for CAH staff participation in state and national conferences, workshops, and other training; access to an on-site, CAH specific, in-depth financial and operational assessment as well as charge master reviews; and lean training and support for implementation. HEALTH SYSTEMS DEVELOPMENT AND COMMUNITY ENGAGEMENT All of Wyoming’s health systems development and community engagement work is directed at local, regional, and state EMS. While most projects will continue, the discussion focused on state legislation affecting EMS agencies, data use/sharing and upcoming training opportunities for EMS staff, and community paramedicine. Current EMS activities include: physician medical director training, EMT-Intermediate classes, EMS leadership training, annual trauma conference speaker, and Trauma Nurse Core Course (TNCC). When asked about current health systems development and community engagement priorities and where the Wyoming Flex Program should focus its resources in FY14, CAH leadership agreed that current projects should continue along with exploring opportunities related to onsite SIM training, Rural Trauma Team Development Course training for CAHs and local EMS, and community paramedicine.

ADDITIONAL INFORMATION For additional information about the Wyoming Flex Program contact Michelle Hoffman at the Wyoming Department of Health, Public Health Division, Office of Rural Health at 307/777-8902 or [email protected].

Wyoming Office of Rural Health Mission: The Wyoming Office of Rural Health seeks to enhance access to healthcare services, support the development of an adequate healthcare workforce, and promote collaboration in expanding comprehensive, community-based healthcare in rural Wyoming. Page 4