Flex Program
- Flex Webinar Learning Series
- Oregon EMS/Trauma Webinar Learning Series
- November 5, 2009, 9:00 a.m.— 11:30 a.m., Flex Advisory Committee Meeting (Open to Critical Access Hospital participants only)
Kassie Clarke, Community Grants Coordinator in the Oregon Office of Rural Health, will provide a brief update on the Flex program and discuss funding opportunities for the ‘09-‘10 grant year. A panel of local hospitals will discuss their efforts in implementing an electronic medical record (EMR), including how to choose a vendor, negotiate a contract, and tips on how to effectively rollout an EMR within your hospital. We will also have a presentation on Quality Leadership for CAHs in Turbulent Times by Ira Moscovice, Mayo Professor and Head, Division of Health Policy and Management, University of Minnesota. The presentation will discuss:- the implications of health care reform for rural health quality;
- how critical access hospitals, both individually and collectively with other hospitals, can take a leadership role in quality measurement and improvement;
- the role of Health Information Technology in rural health policy.
- November 5, 2009,7:30 — 9:00 p.m., Non-Profit Board Training Workshop Reforming Board Healthcare: A Lighthearted Prescription for Common Board Ailments
Join governance author and consultant Bill Charney for an entertaining exploration of commonly accepted behaviors that preclude board effectiveness. In addition to insights and humor about “what is,” Charney will offer suggested prescriptions to help resolve the ailments and help boards achieve the strategic leadership roles they should fulfill.
- ORHQN RPM Benchmarking Meeting
The Oregon Rural Healthcare Quality Network offered a dinner and program sponsored by the Oregon Office of Rural Health on October 8th, to coincide with many Oregon attendees at the NRHA’s annual CAH conference in Portland Oct 7 – 9. Among the topics shared were the top findings from the site optimization visits currently underway, advances in our benchmark report for the entire network, comprehensive use of board reports, and examples of effectively linking strategic plan to RPM.
ORHQN Presentation Slides
PMI Slides
- Lean Workshop and Cost-Based Reimbursement Workshop
The Office of Rural Health and the Oregon Association of Hospitals and Health Systems put together a couple of great workshops this past September prior to the Rural Health Student Recruitment BBQ at Willamette Park. These workshops were focused on rural providers with no charge to CAHs or RHCs.
Workshop Day 1: September 10th from 12:30 pm to 5 pm
Introduction to Lean for Hospital Leadership - This 4 hour session conducted by Kari Penca from Oregon Manufacturing Extension Partnership (OMEP) is targeted specifically at senior hospital leadership and included:- A hands on introduction to Lean concepts and their potential impact on any organization.
- Exercises to begin connecting the general Lean learning to your hospital including identifying specific wastes in your hospital and exploring a few Lean tools that may minimize or eliminate these wastes.
- An overview of a senior leader’s role in transitioning to and sustaining a Lean culture.
Workshop Day 2: September 11th from 9 am to 3 pm
Maximizing Cost-Based Reimbursement – This workshop conducted by Mike Bell, CPA will include a focus on how to receive EMR funding through the stimulus package along with the latest updates on standard billing procedures and RHC regulations.
Stimulus Bill 9
RHC - PB Clinic - FQHC Tables
Strategies - Opportunities Under Cost-Based Reimbursement Tool
New Updates - 2009
Provider-Based RHCs and Provider-Based Clinics
- Student BBQ
- Quality Improvement Project: AMI and Chest Pain in the Emergency Department
- Oregon EMS Mass Casualty Incident Plan and EMS Communications Plan Meetings
- CAH Revised Relocation Guidance and Jan. 1, 2008, Rule Changes (sponsored by the Washington State Office of Community and Rural Health)
- Telehealth Training Series for Critical Access Hospitals and Rural Health Clinics
- Focus on Health Care Finance: Financing Options for Community and Rural Health Care Providers
HRSA is pleased to inform you that the Kid's Toolbox (3 modules) and the ORHP Toolbox (6 modules) have been made publicly available. A blurb for each of the toolboxes have been added to the AHRQ-NRC Health IT Tools Page. Also, links to these toolboxes have been added to the "Related Links" portlet on the Health IT Adoption Toolbox page.
Below are the short URL for each of these toolboxes:
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HIT 101 Presentation
Federal Funding Opportunities from ARRA
- List of Current CAH Hospitals in Oregon
- Materials for Participation – detailed information
- Provision of Observation Services in Critical Access Hospitals
- The revised Rural Health Bookmark (April 2009), which provides information about educational resources that are available to the rural health community, is available in downloadable and print formats.
- The Rural Health Fact Sheet Series (Summer 2009), which provides information about rural facility types and coverage and payment policies, is available in CD-ROM format. The following publications are included in the fact sheet series:
- Critical Access Hospital;
- Federally Qualified Health Center;
- Medicare Dependent Hospital;
- Medicare Disproportionate Share Hospital;
- Rural Health Clinic;
- Rural Referral Center;
- Sole Community Hospital;
- Swing Bed; and
- Telehealth Services.
Below are some links to resources to help you with this process.
- AHRQ
Transforming Hospitals: Designing for Safety and Quality
- HRSA
CAH Prototype - HUD
HUD 242 (FHA Section 242) - Helping Hospitals Get Capital Financing - ORH
Flex Webinar CAH Replacement/Relocation Archive (March 17 + 20 2009)
- Rural Health Resource Center
CAH Prototype
Capital Access - Stroudwater and Associates
2008 Rural Hospital Study
2006 Rural Hospital Study
- USDA
Reconnecting with Community: A Critical Access Hospital Relocation Case Study
We currently have no grant opportunities. If you have any questions related to grant opportunities, please contact Kassie Clarke, Community Grants Coordinator, at 503-494-4450 or e-mail at clarkek@ohsu.edu
Acumentra Health EMS Report to ORH (7/16/2008)
Please click on the image above for a larger image in Adobe Acrobat (pdf) format.
The Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine, under contract with the federal Office of Rural Health Policy are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program).
The monitoring project assesses the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development.
More here: http://www.flexmonitoring.org/
Flex Monitoring Team Briefing Paper No. 17: Differences in Measurement of Operating Margin
A group of interested rural hospitals, state agencies, and other constituents have been working since 2005 to develop the Oregon Rural Healthcare Quality Network (ORHQN).
This network was formed with the goal of improving the quality and safety of rural health care in Oregon. The network will help rural providers overcome common challenges including geographic isolation, lack of opportunity to participate in a larger system, economic challenges, limited educational opportunities, smaller patient census, and limited information technology. The group was awarded federal funding to engage in the process of planning for the network over the next year.
The Community Health Improvement Partnership (CHIP) develops ways to improve local health care and is about people becoming involved in health policy decisions both as individuals and as concerned community members.
What is a Critical Access Hospital (CAH)?
What are the criteria in Oregon for becoming a CAH?
What is a "rural health network"?
What is the role of the State in CAHs?
Will the federal government have more control over the hospital after the conversion?
Why would a hospital consider conversion to a CAH?
What are the steps in becoming a CAH?
What are the key issues that a hospital needs to be aware of in making the transition?
How will the conversion affect the quality of the hospital?
How will the conversion affect the community? The patients?
How will the services offered by the hospital be affected?
How will physicians be affected by the conversion?
Who do I contact to obtain more information?
What is a Critical Access Hospital (CAH)?
Return to Questions
A critical access hospital (CAH) is a hospital designation made possible by the Medicare Rural Hospital Flexibility (Flex) Program created by the federal government in the Balanced Budget Act of 1997. The program is available to any state that chooses to meet the Centers for Medicare and Medicaid Services (CMS) requirements and establish such a program. Oregon has received approval from CMS to create the Oregon Medicare Rural Hospital Flexibility (Flex) Program. A critical access hospital is an alternative for small, rural hospitals that creates the potential for enhanced reimbursement, the opportunity to better match the local community's needs to the hospital's capabilities, and the foundation of a rural health network. The CAH receives cost-based Medicare (and, in Oregon, Medicaid) reimbursement. The bottom line goal of the CAH designation is improved financial viability and stability for the hospital in order to assure access to quality medical care in rural areas.
What are the criteria in Oregon for becoming a CAH?
Return to Questions
In order to satisfy Oregon State requirements for designation as a CAH, a hospital must first agree to meet all Federal requirements for designation. Additionally, the facility must agree to the following state-specific criteria:
- The hospital must be able to demonstrate that a thorough fiscal assessment has determined that conversion to a CAH will be fiscally appropriate.
- The hospital must demonstrate that a community needs assessment has occurred, and indicated that conversion to a CAH is in the best interests of the community.
- The hospital must demonstrate that public notice of the intent to convert to a CAH has occurred, and that the community substantially agrees with the plan.
What is a "rural health network"?
Return to Questions
A rural health network is defined as an organization consisting of at least one CAH and at least one non-CAH hospital where participants have entered into specific agreements regarding patient referral and transfer, communication, and patient transportation. Both partners should benefit from the network arrangement. The critical access hospital has the opportunity to gain clinical and administrative support from its network partner, while the partner can gain enhanced market presence and increased referrals through the critical access hospital.
What is the role of the State in CAHs?
Return to Questions
The State of Oregon recognized that small, rural hospitals are both an indispensable part of their communities and keys to providing quality, accessible health care for all Oregonians. Therefore the Oregon Office of Rural Health developed the State Rural Health Plan and embarked on the creation of the Oregon Medicare Rural Hospital Flexibility Program. The Oregon Office of Rural Health also utilizes an advisory committee, made up of hospital administrators and officials, to oversee the State's efforts in making the critical access program successful.
Will the federal government have more control over the hospital after the conversion?
Return to Questions
No. While the rules under which a CAH operates are different from an acute care hospital, the new designation does not give the federal government any greater control over the hospital. The State is the primary entity that will oversee the operation of the CAH designation program, but they are not granted a higher level of control either.
Why would a hospital consider conversion to a CAH?
Return to Questions
The main goal of the program is to improve the financial viability and stability of the hospital. If the hospital is in need of improved financial status to ensure success and if conversion appears to be a logical move based on the program requirements, then the hospital should strongly consider conversion. A proper financial feasibility study will identify all of the benefits and issues for a hospital as well as help guide the hospital to a proper decision. The main benefit of converting to a critical access hospital is the opportunity for higher Medicare and Medicaid reimbursement. Currently, hospitals receive reimbursement for services based on their costs which, for most small, rural hospitals, should be higher. Other potential benefits from converting the CAH status include:
- Possible cost reductions as a result of the operating guidelines for a CAH,
- Expansion of services and support through the relationship with the network hospital,
- Increased focus and presence in addressing the community's health issues, and
- Potential access to grant dollars from the Oregon Medicare Rural Hospital Flexibility Program.
What are the steps in becoming a CAH?
Return to Questions
Conversion to a Critical Access Hospital under the Medicare Rural Hospital Flexibility Program is a multi-step process with four key steps.
- The interested hospital determines that CAH designation would be beneficial and submits an application to the Oregon Office of Rural Health
- The Oregon Office of Rural Health reviews the hospital's CAH application to ensure all necessary eligibility requirements have been met.
- The state Department of Human Services - Public Health Service's Health Care Licensure and Certification program conducts a survey to ensure the hospital is in compliance with the Medicare Conditions of Participation for critical access hospitals.
- The Centers for Medicare and Medicaid Services (CMS) acts on the state's designation recommendation and issues formal notice of CAH designation.
What are the key issues that a hospital needs to be aware of in making the transition?
Return to Questions
The key issues for each hospital can be thought of in three areas: operational, financial, and community acceptance of the change. Consideration of proper timing and communication is critical to all three. Operationally, the hospital must understand what changes must or will occur in order to be a critical access hospital. In many cases, the conversion will require little or no real change while in other hospitals some substantial change will be desired or required. In either case, the community may perceive it as a major change. These changes must then be communicated to all of the necessary audiences in a way that generates both understanding and support of the changes. The financial feasibility study will address all of the key financial issues. Again, the process and the conclusions of the financial feasibility study are critical to a successful transition.
How will the conversion affect the quality of the hospital?
Return to Questions
No elements of the conversion process should negatively affect the quality of the hospital. The credentialing and quality assurance aspects of the rural health network are in place to maintain a focus on the quality of the critical access hospital. It is also important to note that the regulations governing critical access hospitals allow for an operating standard that is appropriate for rural communities. These different standards do not mean a lower level of quality.
How will the conversion affect the community? The patients?
Return to Questions
While the specific answer to this question is very hospital-dependent, driven to a great degree by the amount of change the hospital chooses to go through, it is critical to remember that the CAH designation and the Oregon Flex Program are both focused on the goal of providing quality, accessible health care for the rural communities of Oregon. From the community's perspective, the goal is to keep the hospital as a vibrant community player focusing on the health needs of the service area. From the patients' perspective, the goal is to meet their needs in the best way possible, especially in regard to emergency and acute care services.
How will the services offered by the hospital be affected?
Return to Questions
The overall goal of each conversion is to create a stronger hospital over the long term. In reviewing changes to existing services (either reductions or expansions), the main factors that will be considered are the 96-hour average length of stay limitation, the financial viability of the hospital, and the relationship with the network hospital(s). Services most likely to be discontinued are those that consistently lead to a length of stay much greater than 96 hours or are highly unprofitable for the hospital. Enhanced reimbursement for services that heretofore had been a financial drain on hospitals would enable expansion of those services identified as needed by the community.
How will physicians be affected by the conversion?
Return to Questions
Reimbursement levels for physicians are not affected by the change to a critical access hospital under the federal rules and regulations currently in place. Compensation of a hospital-employed physician or referral patterns may be affected by changes in services.
Who do I contact to obtain more information?
Return to Questions
In order to learn more or ask additional questions about the Oregon Medicare Rural Hospital Flexibility Program and the Critical Access Hospital designation, please contact Kassie Clarke, phone: 503-494-4450, fax: 503-494-4798, e-mail: clarkek@ohsu.edu.
