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Financial IndicatorsIowa Critical Access Hospital

Performance ImprovementKickoff Webinar

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Project SummaryTransition Framework PresentationOverview: Financial & Operational ImprovementOverview: Quality Improvement NetworkNext Steps

Agenda

FINDINGS

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About this Project

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and

Human Services (HHS) under a grant contract with the State of Iowa.

Grant No.: H54H00011 Title of Program: RURAL HOSPITAL FLEXIBILITY PROGRAM

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The Medicare Rural Hospital Flexibility (Flex) Program was authorized by section 4201 of the Balanced Budget Act of 1997 (BBA), Public Law 105-33. The Flex program provides funding to States for the designation of critical access hospitals (CAHs) in rural communities. Critical Access Hospital designation allows the hospital to be reimbursed on a reasonable cost basis for inpatient and outpatient services (including lab and qualifying ambulance services) provided to Medicare patients. The core areas of the Programs include support for:

• Quality Improvement• Operational and Financial Improvement• Health System Development and Community Engagement

Additional activities within the Flex Program include facilitating the conversion of hospitals to CAH status; supporting network development; and, supporting for workforce issues.

Flex Program Overview

FINDINGS

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Stroudwater designs solutions for healthcare leaders’ most pressing challenges. Founded in 1985, we are a national advisory firm serving exclusively healthcare clients, and we are proud to have friends and clients in all 50 states. We employ thought leadership and focused analytics in a collaborative process that engages our clients and

empowers their transformation.

Our practice areas are highly focused on the mission-critical strategic, operational, and financial areas where our perspective offers the highest

value. Our solutions are client-driven and client-focused. Instead of selling a product or offering a prepackaged solution, we are your trusted advisors on the journey of discovering the unique solution for each client

need.

About Stroudwater

FINDINGS

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• Funded by the Iowa Office of Rural Health through the Rural Hospital Flexibility (Flex) Program

• Available to all Iowa Critical Access Hospitals (CAHs)• Flex grant Fiscal Year September 1, 2017 – August 31, 2018

Project Summary

FINDINGS

QualityImprovement

Financial and OperationalImprovement

Collaborative initiative among all 82 Iowa CAHs to simplify data

collection, benchmark data, identify variation and achieve performance

improvement

CAH-specific consulting engagements for a subset of

eligible facilities (11 CAHs are able to participate

this Flex Fiscal Year)

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Financial IndicatorsTransition Framework

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Transition Framework

FINDINGS

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Financial IndicatorsFinance and Operations

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Project Overview

• The Iowa Department of Public Health (IDPH) has created a program specifically intended to help improve the financial and operational performance of Iowa’s CAHs

• This is a no-cost opportunity, fully funded by the 2018 Medicare Rural Hospital Flexibility (FLEX) Program• The FLEX program aims to improve access to preventative

and emergency healthcare services for rural populations• Participating CAHs will receive a Strategic Financial and

Operational Assessment (SFOA)• The objective of the SFOA is to conduct rapid and focused

analyses of targeted areas within your hospital that result in the identification of both concrete opportunities for operational and financial performance gains and a concise starting point for strategic planning

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Engagement MethodologyPhase 1

Data Request

Phase 2Data Analysis

Stroudwater analysts develop market, service area and historical performance findings to be incorporated into the Final

Report using public, proprietary and hospital-provided data. Data sources

include:

• Detailed IP and OP utilization data • Recently-filed Medicare Cost Reports• Latest PS&R reports• Audited financial statements• Financial and utilization projections

Phase 3Site Visit

Stroudwater conducts a set of onsite key informant

interviews with CEO, CFO, CNO, senior leadership team

members, medical staff, selected department managers and board

members. Prior to site visit departure, preliminary findings

and recommendations are reviewed with senior hospital

leadership

Phase 4aDraft Report

Phase 4bFinal Report

Phase 5Action Planning

Optional component of the Financial & Operational Assessment process

designed to facilitate the development of concrete action

plans based on prioritized recommendations

Stroudwater prepares and submits to hospital

administration a Draft Financial & Operational Assessment

Report based on findings from the Data Analysis and

interviews conducted during the Site Visit. Pending feedback, Stroudwater submits a Final

Report.

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Financial Indicators

SFOAs to Date and Eligibility

2 7Iowa CAHs have

received an SFOAIowa CAHs are Still Eligible for SFOA

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Important Dates and Milestones

November/December 2017• Select CAHs to participate • Kick-off conference call with leadership team• Data request completion

December 2017 - January 2018• Site visit with leadership team• Strategic, financial and operational assessment• Assessment review with leadership team

February – July 2018• Ongoing follow-up and technical assistance

August 2018• Report measurable outcomes and implemented

recommendations

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What’s Next: Finance

Apply Now!

5 52 7Amanda Ramirezamanda.ramirez@idph.iowa.gov

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Our Finance Team

Lindsay Corcoranlcorcoran@stroudwater.comOffice: (207) 221-8262

Jonathan Pantenburgjpantenburg@stroudwater.comOffice: (207) 221-8253

Eric Shelleshell@stroudwater.comOffice: (207) 221-8252

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Financial IndicatorsQuality ImprovementNetwork

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QI Project Timeframe

Kickoff Webinars

Network Face to Face Meeting (B)

EDTC Webinar

Webinar A

Webinar B Webinar C

Network Face to Face Meeting (A)

September 2017

August 2018

Needs Assessment

Data Onboarding

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Quality Improvement Overview

Quality Improvement Components

•MBQIP Four Domains•Patient Safety•Patient Engagement (HCAHPS)•Care Transitions (EDTC)•Outpatient

•MBQIP Four Domains•Patient Safety•Patient Engagement (HCAHPS)•Care Transitions (EDTC)•Outpatient

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MBQIP MeasuresID Measure Name Data Reported To

OP‐1 Median Time to Fibrinolysis  QNet via OP CART/Vendor

OP‐2 Fibrinolytic Therapy Received Within 30 minutes of ED  Arrival

QNet via OP CART/Vendor

OP‐3 Median Time to Transfer to Another Facility for Acute Coronary Intervention 

QNet via OP CART/Vendor

OP‐4 Aspirin at Arrival QNet via OP CART/Vendor

OP‐5 Median Time to ECG QNet via OP CART/Vendor

OP‐18 Median Time from ED Arrival to ED Departure for Discharged ED Patients

QNet via OP CART/Vendor

OP‐20 Door to diagnostic evaluation by a qualified medical professional 

QNet via OP CART/Vendor

OP‐21 Median time to pain management for long bone fracture

QNet via OP CART/Vendor

OP‐22 Patient left without being seen  QNet via Online Tool

OP‐27 Influenza vaccination coverage among healthcare   personnel 

National Healthcare Safety Network Website

IMM‐2 IP Influenza immunization  QNet via CART/Vendor

HCAHPS IP Satisfaction  QNet via Survey Vendor

EDTC Emergency Department Transfer Communication Stroudwater or Other 

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FY 2018 – 21 Measures

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Patient Safety

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Patient Engagement

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Care Transitions - EDTC

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Outpatient

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XXXX Memorial Hospital

State Hospital Action Item Outcome

Memorial Hospital

Initiate Barthel Index with new physical therapy staff

• New physical therapy staff  started. PT/OT staff has started to use Barthel Index on newly admitted swing bed patients. C.N.A. staff has started to receive education on use of Barthel to assist with data collection. 

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Our Quality Team

Carla Wilbercwilber@stroudwater.comOffice: (207) 221-8276

Paula Knowltonpknowlton@stroudwater.comOffice: (207) 221-8259

Gregg Lathropglathrop@stroudwater.comOffice: (207) 221-8266

Contact me if you have questions about the network or want to request TA

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Financial IndicatorsNext Steps

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Next Steps

2 7 5 5Finance Quality

November 20171. Steering Committee (Y/N)2. Survey Monkey3. EDTC Webinar4. Meeting Dates Set

Apply Now!

Work on Action PlansDecember 20171. MBQIP TA Webinar #1

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All Webinar Attendees will Receive a Follow-up Email

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QI Steering Committee

Paula Knowltonpknowlton@stroudwater.comOffice: (207) 221-8259

Contact me if you want to be a member of the Iowa QI Steering Committee

We’re Looking for 4-5 CAH ChampionsContact us by Friday, November 10th

• Review and inform project plan• Suggest geographic breakouts (locations, sequence and timing)• Vet and endorse Needs Assessment survey• Facilitate collaboration with other state-based Quality programs

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Financial IndicatorsComments & Questions