montana rural hospital flexibility and rural healthcare performance improvement network orientation...

Montana Rural Hospital Flexibility

and Rural Healthcare Performance

Improvement Network

Orientation ProgramJune 2011

Some common acronyms…

Flex = Rural Hospital Flexibility Program

PIN = Performance Improvement Network

DPHHS = MT Dept of Public Health and Human Services

MHREF = MT Health Research and Education Foundation, the not-for-profit arm of

MHA

MHA = MT Hospital Association

Some common acronyms…

CAH = Critical Access Hospital

QI = Quality Improvement

PI = Performance Improvement

CMS = Centers for Medicare and Medicaid Services

Montana’s Flex Program MT Grantee = DPHHS Quality Assurance Division

Jeff Buska, Administrator Kathy Lubke, Program Officer

DPHHS contracts with MHREF to administer Flex funded activities

DPHHS retains program evaluation and fiscal management responsibilitiesFlex grant year runs from September 1 thru August 31

Flex/PIN StaffFlex Director

Carol Bischoff 457-8016 carol@mtha.org

Rural Hospital Quality Coordinator

Kathy Wilcox 461-6186 kathy@mtha.org

St. John’s Lutheran Hospital

Clark Fork Valley Hospital

Mineral Community Hospital

Marias Medical Center

Liberty Medical Center

Pondera Medical Center

Teton Medical Center

Missouri River Med. Center

Big Sandy Med. Center

Powell Co. Medical Center

Granite Co. Medical Center

Ruby Valley Hospital

Barrett Memorial Hospital

Mountainview Medical Center

Livingston Healthcare

Pioneer Medical Center

Stillwater Comm. Hospital

Beartooth Hosp. & Health Center

Rosebud Health Care Center

Dahl Memorial Healthcare Assoc.

Fallon Medical Complex

Prairie Community Hospital

Garfield Co. Health Center

McCone Co. Health Center

Roosevelt Med. Center

Poplar Comm. Hospital

Sheridan Memorial Hosp.

Frances Mahon Deac. Hospital

Phillips County Hospital

Wheatland Memorial Healthcare

Montana Critical Access Hospital Program Status

June 2011

Critical Access Hospitals

Potential Critical Access Hospital

Broadwater Health Center

Madison Valley Hospital

St. Luke Comm. Hospital

Glendive Medical Ctr

Big Horn County Memorial Hospital

St. Joseph Hospital

Community Hospital of Anaconda

Marcus DalyMemorial Hospital

North Valley Hospital

Northern Rockies Medical Center

Daniels Memorial Healthcare Center

•NE MT Health Services

Fort Belknap Service Unit

Crow/N. Cheyenne Indian Hospital

Roundup Memorial Healthcare

Sidney Health Center

Blackfeet Comm. Hospital

Central Montana Medical Center

Holy Rosary Healthcare

Flex Grant Core Areas 2010-2011

• Quality Improvement

• Operational and Financial Improvement

• Health System Development and

Community Engagement

Flex Grant Activity Sampler

Core activitiesQA/QI/PI: CoP assistance and other quality based projects: benchmarking,

clinical improvement & benchmarking, quality education & support networkMeetings: CEO x 2, DON Forum, QI Showcase, Champions for Quality,

Regional QIC/DONCoding workshops

Other projects vary from year to yearCAH CFO networking optionsHIT web-based resource bookFacility specific economic impact reportsCost report reviewLeadership InstituteLean internshipsPIN websiteTHE LIST IS ALMOST ENDLESS!

• Continue Clinical Improvement Studies (CIS) • CIS Lunchtime Learning• CAH Peer review• Credentialing education • Benchmarking/Clinical benchmarking • Networking Meetings • PIN website • PI/QA/QI Education and resources• Prevent Transmission of MRSA collaborative w/ QIO, DPHHS• Maintain HIT website• HIT Training

Goal #1-Support efforts to improve and sustain quality of care

Precursor to value-based purchasing for CAHs?

Phase 1 Measures (one-year time frame 2011-2012) Pneumonia: Hospital Compare CMS Core MeasuresCongestive Heart Failure: Hospital Compare CMS Core Measures Phase 2 Measures (one-year time frame 2012-2013)Outpatient 1-7 as specified in Hospital Compare (AMI-ED, SCIP)Hospital Consumer Assessment of Healthcare Providers and Systems 

Phase 3 Measures (one-year time frame 2013-2014)Pharmacist Review of OrdersOutpatient Emergency Department Transfer Communication

The Flex Medicare Beneficiary QI Project

…aka MBQIP!

• Meetings: Administrator, Nursing Directors• Coding workshops• CFO Networking• Medical necessity determination (RAC)• Explore capital funding options• Leadership Institute• Lean internships

Goal #2- Support efforts to improve Montana CAH financial and operational performance

• GEMS-Geriatric Emergency Medical Services

• CHSD-Community Health Services Development

Year 5-Needs assessment and community health care planningFallon Medical Center in Baker, Madison Valley Hospital in Ennis, Holy Rosary in Miles City, Dahl Memorial in Ekalaka, Rosebud Health Care Center in Forsyth, Prairie Community in Terry and Clark Fork Valley Hospital in Plains

• MT Rural Health Plan

Goal #3- Support efforts to assist CAHs in developing systems of care, addressing community needs

Flex Networking/Ed Activities 2010-2011

Champions for Quality 2011

“Back to the Future”

July 14-16, 2010

Great Northern Hotel HelenaMedical Education, CMEs, Nursing CE credits

100% say this conference is worth their time to attend!

Lunchtime Learning:another opportunity for provider education

Flex Networking/Ed Activities 2011

• CAH Administrators Billings Sept 21, 2011

• Joint QI Coordinators & DONs Regional Meetings

Oct 2011; dates & locations to be announced

• CAH Administrators Jan 2012

• DON Forum March 2012

• QI Showcase, Fairmont April 2012

Flex Networking/Ed Activities 2010-2011

• Coding workshops: 5th year!

• CFO Networking: ListServe; HFMA attendance

• Credentialing: MTAMSS Conference June 2011

Sustainable Leadership 2010-2011

• Leadership Institute

• Lean Process ManagementNorth Valley Hospital, WhitefishNorthern Rockies, Cut BankBroadwater Health Center, TownsendMcCone County Health Center, CircleRosebud Health Care Center, ForsythFallon Medical Center, Baker

Flex HIT Support Activities 2010-2011

• HIT Technical Assistance website

www.mtpin.org HIT Resource Guide

Username MT CAH48

Password HIT Resource

• HIT Education Programs

HIT Certification Program- MT Tech, Butte

IT/HIT Literacy- Helena College Of Technology

Significant Flex resources support

the Montana Rural Healthcare

Performance Improvement Network (PIN)

Performance Improvement Network• Formed at request of CAH CEOs in 2001

• All 48 MT CAHs are members

• Governance provided by PIN Advisory Board

up to 10 members: CEOs, DONs, QI/PI

• Clinical oversight provided by the Clinical

Improvement Panel (CIP)

Performance Improvement (PI) Program

C-0191 Agreements with qualified entities

C-0195 Agreements for Credentialing and Quality Assurance

C-0271 Clinical policies and procedures

Performance Improvement (PI) Program

C-0330 “Periodic Evaluation”, ie, the Annual CAH Program

Evaluation

C-0336 “An effective QA program”:the expectation of measurable

improvement

C-0337 All patient care and other services affecting patient health and safety are evaluated

Performance Improvement (PI) Program

C-0338 Includes nosocomial infections and medication therapy

C-0339 Includes quality and appropriateness of diagnosis

and treatment (ie, “peer review”)

C-0341 Considers findings and recommendations from

the QIO and takes corrective action

C-0342 Takes appropriate remedial action to address deficiencies found through the QA program (ie, CAH survey deficiencies)

Performance Improvement (PI) Program

•Provides support for in-house PI staffOpportunities for improving performance• Clinical improvement studies, clinical

benchmarking

Education, training and PI resources• PIN Education Committee

Regulatory information and support (CMS)• Tag by tag review; fourth Wed each month, 2 pm

Performance Improvement (PI) Program

Support for in-house staff, cont.

Consultation• onsite as requested

– Networking opportunities• sponsored meetings

Engaging administration and medical staff• Administrator meetings; Champions for Quality;

clinical improvement panel and studies

Facility Staff Support Resources

• “Best Practice” tools, resources and education

• PIN ListServ pin@astro.lyris.net

• Quarterly PIN newsletter

• PIN website www.mtpin.org

• 11 years in the development

• 13 indicators initially; 25 currently

• 94% reporting rate in 1st quarter 2011

Continually refining metrics & peer groups

PIN Benchmarking Project

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

XYZ Hospital 57.4 61.0 61.5 69.3 62.2 59.8 57.0 67.7

Peer group Max 83.6 84.3 91.1 76.4 84.0 92.0 90.7 84.0

Peer group Avg 68.5 69.5 71.6 70.4 70.5 71.1 72.2 70.8

Peer group Min 57.4 52.0 56.8 64.7 56.2 50.7 57.0 62.4

Average of 2003-Qtr 3

Average of 2003-Qtr 4

Average of 2004-Qtr 1

Average of 2004-Qtr 2

Average of 2004-Qtr 3

Average of 2004-Qtr 4

Average of 2005-Qtr 1

Average of 2005-Qtr 2

LOS (hours)

Peer Group 1

Sample report

8 quarters5 Peer Groups

Clinical ImprovementStudies Program

• Clinical Improvement Studies (CIS)2 studies underway at all times

• Clinical Improvement Panel (CIP)8 PIN Physician volunteers2 PIN mid-level volunteers

• CIS Development Committee (CIS-DC)DON and QI/PI Coordinator volunteers

CIS Program 2011

• Patient Safety : Prevent MRSA Transmission

• Pediatric Emergency Care: completed May 2011

• Clinical Benchmarking Project Pressure Ulcers, HF, CAP, Stroke, Inter-facility Transfer measures, Reduce Preventable Falls

• Quality Awards: 2011 recipient criteria Applications due August 1, 2011 You MUST apply to receive an award!

PIN Lessons Learned

• Leadership commitment is essential

• Involve more than CEOs

• Clarifying program responsibility and accountabilities in the facility are essential (not just the coordinator)

• Frequent communication

• “What gets measured gets managed”

QUESTIONS?

Cultural transformation isa slow, deliberate, strategic

process.