Hospital State Division

Hospital State Division

Kristi MartinsenHospital State Division Director

HSD OverviewSeptember 2013

Department of Health and Human ServicesHealth Resources and Services Administration

Office of Rural Health Policy

Hospital State Division - Regional LiaisonsDan Mareck Keith Midberry

E

David DietzMegan Meacham

C

Jeanene MeyersNatassja Manzanero

A

Steve Hirsch

D

Bridget WareSarah Young

B

Hospital State Division

ORHP Project Officers

TA Partners (NOSORH, TASC, FMT)

Grantees

Collaborative Partnership

Office of Rural Health Policy (ORHP) ActivitiesImproving Rural Health Initiative

“Within the total amount

requested for Rural Health

Activities, the Budget includes

$79 million to continue the

President’s initiative to improve

rural health. The goal of this

initiative is to improve the

access to and quality of health

care in rural areas.”

Office of Rural Health Policy (ORHP) ActivitiesImproving Rural Health Initiative: Key Elements

•Building a Programmatic “Evidence Base”

•Health Workforce Recruitment & Retention

•Telehealth/ HIT Coordination

•Cross Governmental Collaboration

Hospital State Division (HSD)Overview

• Measuring and Improving Outcomes• Using and Sharing the Program Data• Collaborating and Sharing Best

Practices• Aligning Programs to the Health Care

Environment• Program Integrity

• Grants• State Offices of Rural Health

(SORH)• Medicare Rural Hospital

Flexibility Program (FLEX)• Small Hospital Improvement

Program (SHIP)• Initiatives

• Flex Medicare Beneficiary Quality Improvement Project (MBQIP)

• Delta Rural Hospital Performance Improvement Project (RHPI)

Focus Programs

Hospital State Division (HSD)Grants: State Offices of Rural Health (SORH)

• State / Federal partnership • assist States in strengthening rural

health care delivery systems• Establish & maintain clearinghouse• Coordinate activities within state to

avoid duplication of effort & activities. • Provide technical assistance• Encourage recruitment & retention of

health professionals

• FY 13 grant guidance competitive• New 3 year project period

• Submit via Grants.gov• Focus on key SORH activities for all 50

states

Purpose Awards

Hospital State Division (HSD)SORH Grant TA Partners

• National Organization of State Offices of Rural Health

• Provide education, resources and TA to State SORH Programs

• http://www.nosorh.org

Need

Assessment

Activities

Measures

Outcomes

Grantee (State) Process

Program (National) Context

Hospital State Division (HSD)Grants: Outcomes Focus – Quality and Performance Improvement

Hospital Level

State Program Level

National Program Level

Determine Effective Interventions

Refine Flex Program Activities

Hospital State Division (HSD)Grants: Small Rural Hospital Improvement Program (SHIP)

• Encouraging Networking• Strategically Using Grant Dollars• Updated SHIP Categories Aligned to

Affordable Care Act• ICD 10 Updates:

http://www.cms.gov/ICD10/

• Competitive in FY 13: Awards coming out any day for 9/1 start date

**In 2016 will change to a 6/1 start date

• Anticipated amount of award: ~ $8800 per hospital

• FY13 SHIP Focus:• MBQIP Activities (Inpatient and

HCAHPS)• ICD-10• Innovations group for health IT

projects and community-based interventions

Purpose Awards

Hospital State Division (HSD)SHIP Grant TA Partners

• Technical Assistance and Services Center• Provide education, resources and TA to State SHIP

Programs

• http://www.ruralcenter.org/tasc

Hospital State Division (HSD)

• Four Core Focus Areas:

Grants: Medicare Rural Hospital Flexibility Program (FLEX)

•Support for Quality Improvement in CAHs

•Support for Operational & Financial Improvement in CAHs

•Support for Health System Development and Community Engagement•Including integrating EMS in regional and local systems of care

•Designation of CAHs in the State

Flex In Motion

Need

Assessment

ActivitiesMeasures

Outcomes

Hospital State Division (HSD)Flex Grant TA Partners

• Technical Assistance and Services Center• Provide education, resources and TA to State Flex

Programs and CAHs

• http://www.ruralcenter.org/tasc• Flex Monitoring Team

• CAH Financial Indicator Reports• State Hospital Compare & Quality Measure Reports• Other briefs & reports yearly on quality, finance, and

community engagement

• www.flexmonitoring.org

• Pilot project focusing upon quality improvement and data reporting

• Common clinical and process metrics (i.e., syncing with NQF and Hospital Compare)

• Measuring outcomes and demonstrating improvements via evidence-based practices

• Sharing evidence-based practices

http://www.hrsa.gov/ruralhealth/about/video/index.html

Medicare Beneficiary Quality Improvement Project (MBQIP)

Hospital State Division (HSD)Medicare Beneficiary Quality Improvement Project (MBQIP)

Total CAHsCAHs

participating% participation

1331 1226 92%Goal: 100%

• Reporting on Rural-Relevant and Common National Measures

• Measuring Outcomes and Demonstrating Improvements

• Sharing Best Practices

Hospital State Division (HSD)

http://www.hrsa.gov/ruralhealth/about/video/index.html

Medicare Beneficiary Quality Improvement Project (MBQIP)

• Pneumonia: Hospital Compare CMS Core Measure (participate in all sub-measures); AND

• Congestive Heart Failure: Hospital Compare CMS Core Measure (participate in all sub-measures)

Phase 1 Measures (Begin September 2011)

• Outpatient 1-7: Hospital Compare CMS Measure (all sub-measures that apply); AND

• Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Phase 2 Measures (Begin September 2012)

• Pharmacist CPOE/Verification of Medication Orders Within 24 Hours; AND

• Outpatient Emergency Department Transfer Communication• *Reporting tool for Phase 3 Measures is yet to be determined

Phase 3 Measures* (Begin September 2013)

Health Reform Initiatives

• Reduce harm caused to patients in hospitals.

We will accelerate the reduction of preventable harms to inpatients starting now, so that by the end of 2013 we will observe a 40% reduction in preventable harm compared to 2010. Based on our calculations, this would mean almost two million fewer injuries to patients and more than 60,000 lives saved.

• Reduce preventable hospital readmissions.

We will advance efforts to decrease preventable hospital readmissions within 30 days of discharge, so that by 2013 all readmissions would be reduced by 20% compared to 2010. This would mean prevention of more than 1,600,000 hospital readmissions.

Achieving these two goals will not only save lives and greatly reduce injuries to millions of

Americans, it will also result in savings of billions of dollars that help put the nation on

the path to having a more sustainable health care system.

Partnership for Patients

White House Rural Council

Expand NHSC to CAHs

•Began in 2012•15 clinicians receiving repayment (July)•34 clinicians applied for repayment (July)

Promote HIT in Rural Areas•Collaboration with USDA•Access to Capital•Rural HIT Workforce Training•www.raconline.org/hit/

Office of Rural Health Policy (ORHP) ActivitiesWhite House Rural Council

• Access to Capital Workgroup • August 2012• Brought together federal partners and rural

stakeholders to discuss challenges and opportunities

• Upcoming resource guide for SORHs and rural hospitals on capital resources

Resources Workforce: Linking Rural Health Care Providers to the Federal Workforce Programs • HRSA Programs such as...

• National Health Service Corps• Nursing Loan Repayment • Primary Care Training• Nursing Education

• Key Challenge: Linking Providers & Educational Institutions

• http://www.hrsa.gov/ruralhealth/pdf/ruralhealthfundingguidance.pdf

ORHP Affordable Care Act Activities

•Weekly Office Hour Calls

• Wednesdays, 3-4 pm Eastern Time• Call-in Number: (800) 857-3749; Passcode: ORHPACA• Adobe Connect Session: https://hrsa.connectsolutions.com/orh1/• 6/13 Topic: ACA 101 • 6/27 Topic: ACA Medicaid Expansion 101• 7/10 Topic: Consumer Assistance • 7/17 Topic: SHOPs, Tax Credits/Subsidies, and the Unbanked Population  • 7/24 Topic: Minimum Coverage Provision, Exemptions, Subsidies and Dual

Eligibles• 7/31 Topic: Consumer Assistance

•Questions and Distribution List

• [email protected]: Email this address with any questions and if you want to be added to the ORHP distribution list for emails on resources and call information

Ask Insurance Commissioners/Marketplace which Qualified Health Plans (QHP) are participating.

Inform QHPs if you are an Essential

Community Provider.

Begin negotiating

contracts with QHPs.

Educate QHPs about your role

in rural communities.

Refer patients to

Healthcare.gov.

Talk to your patients about their eligibility and enrollment

options.

Refer patients to Consumer Assistance

Programs in your state.

What kind of Marketplace does your state have?

What rural providers need to know about the Health Insurance Marketplaces:

STEP 1:

STEP 2:

STEP 3:

STEP 4:

How many uninsured individuals are in

your area?

Contact Information

Kristi Martinsen

Hospital State Division Director

301-594-4438

[email protected]

www.hrsa.gov/ruralhealth