COMMENTARY
The Medicare Flex Program: A Partner in Improving Quality of Care in Critical Access Hospitals David Dietz, MHSA, MSW & Megan Z. Meacham, MPH Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
Disclosure: This article was required to be submitted to the Department of Health and Human Services, Health Resources and Services Administration, for review and approval prior to author submission. For further information, contact: David Dietz, MHSA, MSW, Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services, 5600 Fishers Lane, 5A-05, Rockville, MD 20857; e-mail: [email protected]. doi: 10.1111/jrh.12091
Since 1997, the Medicare Rural Hospital Flexibility Grant Program (Flex Program) has been assisting Critical Access Hospitals (CAHs) with improving a variety of quality indicators and operational functions, and increasing access to health care services for rural beneficiaries and their families through CAH designation. The federal Office of Rural Health Policy (ORHP) funds State Offices of Rural Health (SORHs), and it partners with grantees known as Flex coordinators in the states where CAHs are located to engage in this work. Authorized in Section 1820(j) of the Social Security Act (42 U.S.C. 1395), the Flex Program focuses on 4 core areas: 1. Support for quality improvement in CAHs; 2. Support for financial and operational improvement in CAHs; 3. Support for health system development and community engagement, including integrating Emergency Medical Systems (EMS) in regional and local systems of care; and 4. Designation of CAHs within a particular state. Much has changed since the Flex Program’s inception. What began as fewer than 100 participating CAHs has now become a national quality improvement program, affecting more than 1,300 CAHs in 45 states. Flex coordinators face a daunting task in balancing activities within
c 2014 National Rural Health Association The Journal of Rural Health 31 (2015) 119–120
each of the 4 core areas, as the number of CAHs per state can range from 3 to more than 80. As a result, many Flex coordinators have organized CAHs into cohorts, or networks that focus on a set of specific activities, ranging from quality improvement activities or financial/operational sustainability activities, to EMS classes and leadership trainings. The ORHP also funds the Flex Monitoring Team (FMT), a consortium of researchers from the University of Minnesota, the University of North Carolina, and the University of Southern Maine. The FMT plays an integral role in monitoring and evaluating the Flex Program and assessing its impact on rural hospitals and the communities they serve. Recommendations from the FMT provide guidance to the ORHP on the direction of Flex Program activities and drive improvements nationwide. Perhaps the most significant addition to the Flex Program is the Medicare Beneficiary Quality Improvement Program (MBQIP). Launched in September 2011, the MBQIP aids Flex coordinators in the development of a framework to measure quality improvement. To emphasize the importance of providing the highest quality care no matter how low the patient volume, the MBQIP aims to increase voluntary CAH participation in tracking and reporting quality data through a set of rural-relevant measures for inpatient and outpatient services. The MBQIP also encourages CAHs to use the
119
The Medicare Flex Program
data to implement necessary improvements. In addition to performance measures set by Medicare’s Hospital Compare and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), 2 additional measures for emergency department transfer communications and pharmacist verification of orders were phased in as of September 2013. Within a year of implementation, more than 90% of CAHs were participating in the MBQIP, realizing the ORHP’s vision to create a contextual framework through which to collect and store CAH quality data, as well as a launching point for rural quality improvement projects.
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The evolution of the MBQIP continues. Since 2011, the FMT has been involved in testing and studying the implementation of the Outpatient Emergency Department Transfer Communication Measures in 79 Minnesota CAHs. The goal is to help hospitals significantly improve care transitions, and in turn reduce preventable hospital readmissions. This critical study, “Implementation of Emergency Department Transfer Communication Measures in Minnesota Critical Access Hospitals” (published in this issue of The Journal of Rural Health) informs the latest MBQIP phase and will serve both Flex coordinators and CAH staff as a guide to improving patient care at the point of discharge or transfer.
c 2014 National Rural Health Association The Journal of Rural Health 31 (2015) 119–120
The Medicare Flex Program: A Partner in Improving Quality of Care in Critical Access Hospitals David Dietz, MHSA, MSW & Megan Z. Meacham, MPH Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
Disclosure: This article was required to be submitted to the Department of Health and Human Services, Health Resources and Services Administration, for review and approval prior to author submission. For further information, contact: David Dietz, MHSA, MSW, Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services, 5600 Fishers Lane, 5A-05, Rockville, MD 20857; e-mail: [email protected]. doi: 10.1111/jrh.12091
Since 1997, the Medicare Rural Hospital Flexibility Grant Program (Flex Program) has been assisting Critical Access Hospitals (CAHs) with improving a variety of quality indicators and operational functions, and increasing access to health care services for rural beneficiaries and their families through CAH designation. The federal Office of Rural Health Policy (ORHP) funds State Offices of Rural Health (SORHs), and it partners with grantees known as Flex coordinators in the states where CAHs are located to engage in this work. Authorized in Section 1820(j) of the Social Security Act (42 U.S.C. 1395), the Flex Program focuses on 4 core areas: 1. Support for quality improvement in CAHs; 2. Support for financial and operational improvement in CAHs; 3. Support for health system development and community engagement, including integrating Emergency Medical Systems (EMS) in regional and local systems of care; and 4. Designation of CAHs within a particular state. Much has changed since the Flex Program’s inception. What began as fewer than 100 participating CAHs has now become a national quality improvement program, affecting more than 1,300 CAHs in 45 states. Flex coordinators face a daunting task in balancing activities within
c 2014 National Rural Health Association The Journal of Rural Health 31 (2015) 119–120
each of the 4 core areas, as the number of CAHs per state can range from 3 to more than 80. As a result, many Flex coordinators have organized CAHs into cohorts, or networks that focus on a set of specific activities, ranging from quality improvement activities or financial/operational sustainability activities, to EMS classes and leadership trainings. The ORHP also funds the Flex Monitoring Team (FMT), a consortium of researchers from the University of Minnesota, the University of North Carolina, and the University of Southern Maine. The FMT plays an integral role in monitoring and evaluating the Flex Program and assessing its impact on rural hospitals and the communities they serve. Recommendations from the FMT provide guidance to the ORHP on the direction of Flex Program activities and drive improvements nationwide. Perhaps the most significant addition to the Flex Program is the Medicare Beneficiary Quality Improvement Program (MBQIP). Launched in September 2011, the MBQIP aids Flex coordinators in the development of a framework to measure quality improvement. To emphasize the importance of providing the highest quality care no matter how low the patient volume, the MBQIP aims to increase voluntary CAH participation in tracking and reporting quality data through a set of rural-relevant measures for inpatient and outpatient services. The MBQIP also encourages CAHs to use the
119
The Medicare Flex Program
data to implement necessary improvements. In addition to performance measures set by Medicare’s Hospital Compare and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), 2 additional measures for emergency department transfer communications and pharmacist verification of orders were phased in as of September 2013. Within a year of implementation, more than 90% of CAHs were participating in the MBQIP, realizing the ORHP’s vision to create a contextual framework through which to collect and store CAH quality data, as well as a launching point for rural quality improvement projects.
120
Dietz and Meacham
The evolution of the MBQIP continues. Since 2011, the FMT has been involved in testing and studying the implementation of the Outpatient Emergency Department Transfer Communication Measures in 79 Minnesota CAHs. The goal is to help hospitals significantly improve care transitions, and in turn reduce preventable hospital readmissions. This critical study, “Implementation of Emergency Department Transfer Communication Measures in Minnesota Critical Access Hospitals” (published in this issue of The Journal of Rural Health) informs the latest MBQIP phase and will serve both Flex coordinators and CAH staff as a guide to improving patient care at the point of discharge or transfer.
c 2014 National Rural Health Association The Journal of Rural Health 31 (2015) 119–120
