small rural hospital transition (srht) project · lindsay corcoran, mha stroudwater associates...
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Small Rural Hospital
Transition (SRHT) Project
Quality Improvement (QI)
_____________Hospital Work Plan
525 South Lake Avenue, Suite 320 │ Duluth, Minnesota 55802
(218) 727-9390 │ [email protected]
Get to know us better: www.ruralcenter.org/rhi
The Small Rural Hospital Transition (SRHT) Project is supported by Contract Number
HHSH250201600012C from the U.S. Department of Health and Human Services, Health
Resources and Services Administration, Federal Office of Rural Health Policy
RURAL HEALTH INNOVATIONS 2
TABLE OF CONTENTS
Small Rural Hospital Transition (SRHT) Project .................................................. 3
Quality Improvement (QI) Project Objectives ................................................. 3
_____________Hospital Work Plan .................................................................. 4
Hospital Readiness for A SRHT Project .............................................................. 5
Who Should Be Involved In the Project? ........................................................... 6
Executive Leadership ................................................................................... 6
Management Team ...................................................................................... 6
SRHT Consultation Method .............................................................................. 7
First Onsite Consultation Visit: Interviews ...................................................... 7
Second Onsite Consultation Visit: Report Presentation and Action Planning ........ 7
Contact Information ....................................................................................... 8
SRHT Project Contact Information ................................................................. 8
Consultant Contact Information .................................................................... 8
Appendices.................................................................................................... 9
Appendix A: QI Interview schedule and First Onsite Consultation Agenda ......... 10
_______ Hospital Interview Schedule ....................................................... 10
Appendix B: QI Project Data Request .......................................................... 11
Instructions ........................................................................................... 11
_____________ Hospital Data Request Table ............................................ 12
Appendix C: QI Anticipated Outcomes and Tracking Measures ........................ 17
Appendix D: HCAHPS Survey Questions for QI SRHT Tracking Measures .......... 18
Appendix E: Recommendation Adoption Progress (RAP) Interview Questions .... 19
RURAL HEALTH INNOVATIONS 3
SMALL RURAL HOSPITAL TRANSITION (SRHT) PROJECT
The Small Rural Hospital Transition (SRHT) Project was created by the Federal
Office of Rural Health Policy to assist rural communities and their hospitals in
successfully navigating the changing health care environment. The SRHT Project
supports small rural hospitals nationally by providing on-site technical assistance
(TA) to help them bridge the gaps between the current fee-for-service system and
the newly emerging one based on quality and value. The SRHT Project supports
nine (9) selected small, rural hospitals with onsite TA in the core areas of financial
and operational assessments (FOA) and quality improvement (QI) projects. At least
three (3) hospitals are selected for each core area of FOA and QI projects.
The SRHT Project is designed to transition rural hospitals to value-based care and
payment models, as well as prepare them for population health management. While
the technical assistance helps leaders with improving their hospitals’ financial and
quality performance, the primary focus is to support them in preparing their
facilities for participation in value-based care models and payment systems (such
as patient-centered medical homes and shared savings programs) that position
their hospitals for the future.
Quality Improvement (QI) Project Objectives
QI projects assess care management processes to determine opportunities for
improvements. QI projects provide best practice recommendations that improve
quality scores and reporting, as well as patient outcomes. The recommendations
provide guidance to hospitals for initiating community care coordination activities to
support future population health management. QI projects assess:
Care management processes that targets utilization review, discharge
planning, care coordination and resource utilization to yield cost-effective
quality outcomes that are patient-centric and safe
Inter-departmental coordination that impacts transitions of care
Hospital’s application of best practice processes that impact patient-centered
care and care coordination
QI projects provide hospital teams with a report of the findings and
recommendations, as well as an action plan with specific, measurable outcomes to
improve performance and position the hospital for the future.
_____________HOSPITAL WORK PLAN
Hospital Activity Deadline
Complete pre-project planning activities
Perform an online transition planning self-assessment prior to planning calls
Hold a project planning call with the consultant and SRHT Project Staff at 5 - 6
weeks prior to first onsite consultation. Call hosted by SRHT Project staff.
Submit data request to consultant at [email protected]
Submit interview schedule to Bethany Adams at [email protected]. Interview
schedule is agenda for the first onsite consultation
Hold a second project planning call with the consultant 1 week prior to the first
consultation date. Call hosted by consultant.
First onsite consultation – one (1) day onsite at hospital
Hold interviews with executive and management teams following the interview
schedule
Refer to who should participate
Hold exit interview with CEO
Review report
CEO to submit feedback on report to the consultant to prepare for the second onsite
visit. A call may be held with the consultant, if needed, to review the report and
recommendations. CEO should schedule this call directly with the consultant.
Second onsite consultation – One (1) day onsite at hospital
Present report and recommendations to executive and management teams, key
staff, medical staff and board members through one meeting
Develop action plan with executive and management team members to implement
best practice recommendations to improve processes and maximize performance
Develop strategies with executive team that prepare the hospital for transitioning to
a value-based system
Refer to who should participate
Finalize report and action plan
Report is considered final after two weeks following the consultation
Complete post-project activities
Monitor progress using SRHT tracking measures for 12 months
Hold first Recommendation Adoption Progress (RAP) interview at 5 months post-
project. Rhonda Barcus will coordinate the call
Submit post-project values at 12 months to [email protected] prior to RAP
call
Hold second (final) RAP interview at 12 months post-project
Retake an online transition planning self-assessment at 12 months
TBA by
Rhonda
Barcus
HOSPITAL READINESS FOR A SRHT PROJECT
Consultation services are provided to selected hospitals that are deemed ready,
willing and able to undertake a comprehensive project. Selected hospitals must be
willing and able to meet program requirements and project expectations. Selected
hospitals must be prepared to:
Initiate and complete project within the defined timeline of their work plans
Perform a transition planning self-assessment prior to and following the
consultation at 12 months post-project
Schedule and reserve onsite consultation dates (projects may not be
rescheduled nor rolled over to the next fiscal year)
Meet deadlines and respond in a timely manner
Submit data requests by deadlines (refer to Appendix B for QI data request)
Submit interview schedule for first onsite visit by deadlines (refer to
Appendix A for QI interview schedule)
Track SRHT Project measures and report pre-/post values (refer to Appendix
C for QI Anticipated Outcomes)
Provide pre-/post values for SRHT tracking measures
Prepare the board, management team and any other team champions for the
onsite consultations
Utilize resources available through the Transition Toolkit to support the
implementation of best practices and transition process
Implement consultant recommended best practices and transition strategies
Demonstrate measurable outcomes and show impact from the project
activities
Complete a Recommendation Adoption Progress (RAP) interview at 5 and 12
months post-project (refer to Appendix E for RAP interview questions)
Share successful strategies and project outcomes with other rural hospitals
through PMG calls, Hospital Spotlights, and possible state network meetings
Participate in HELP webinars and PMG calls to build staff capacity that
supports the implementation process and sustains post-project gains
Hospitals unable to meet program and readiness requirements, to include
deadlines, will be placed back in queue for future consideration and the
consultation slot will be provided to the next ranked hospital.
RURAL HEALTH INNOVATIONS 6
WHO SHOULD BE INVOLVED IN THE PROJECT?
Executive Leadership
SRHT Projects are large, comprehensive consultations that require top leadership
involvement from the executive team to include the chief executive officer (CEO),
chief financial officer (CFO), chief nursing officer (CNO), chief operating officer
(COO) and chief information officer (CIO). The SRHT Project requires the hospital
CEO to be actively involved and engaged in the consultation. The CEO is expected
to facilitate the project planning and onsite consultations, implement best practices
and transition strategies, as well as follow-up with SRHT staff to complete feedback
assessments and RAP interviews. SRHT will not accept a representative in lieu of
the CEO.
Management Team
The hospital’s management team should be actively involved and prepared to
participate in the interviews and action planning. Key team members include:
Care management team members
Case manager(s) / UR staff
PI/QI Director
Clinic Director and Clinic Manager
HIM Director, Medical Records staff and Coders
ED Medical Director
ED Nurse Manager
Ancillary clinical leaders
Clinic Director
Nursing Home / skilled nursing facility (SNF) Directors
Other key staff that play a role in care management and transitions of care
Hospital teams should work collaboratively with the consultant to develop action
steps to implement recommended best practices to improve care management and
transitions of care processes, as well as develop strategies to transition to a value-
based system. These champions should be engaged throughout the project to
successfully implement consultant recommended best practices.
RURAL HEALTH INNOVATIONS 7
SRHT CONSULTATION METHOD
First Onsite Consultation Visit: Interviews
The first consultation visit consists of a full day of interviews with executive and
management team members, medical staff and board members. The first
consultation visit focuses on finding opportunities for performance improvement, as
well as discovering strategies that support the hospital’s transition process.
Additional data may be requested as follow-up to consultation. Refer to Appendix A
for the QI Interview Schedule Template. The interview schedule outlines the
agenda for the first onsite consultation.
Second Onsite Consultation Visit: Report Presentation and Action
Planning
The second onsite visit requires a full day for the executive and management
teams. Executive and management teams should participate in both the report
presentation and action planning sessions. The first half of the day consists of the
report presentation to the executive and management teams, as well as the board
members, medical staff and any other key community champions that the CEO
would like to invite. The remaining half of the day is devoted to the action planning
process. The objective is to provide the hospital teams with a clear understanding
of the opportunities and recommendations so that the:
Management teams can develop action plans to implement the best practice
recommendations at the department level; and
Executive team can develop strategies that positions the hospital for the
future and transitions them to a value-based system.
RURAL HEALTH INNOVATIONS 8
CONTACT INFORMATION
SRHT Project Contact Information
Bethany Adams, MHA, FACHE, MT(ASCP)
National Rural Health Resource Center
Rural Health Innovations, LLC
Senior Program Manager 525 S. Lake Avenue, Suite 320 Duluth, MN 55802
Direct: (859) 806-2940 Email: [email protected]
http://www.ruralcenter.org
Rhonda Barcus, MS, LPC
National Rural Health Resource Center
Rural Health Innovations, LLC
Program Specialist 525 S. Lake Avenue, Suite 320 Duluth, MN 55802
Direct (904) 321-7607 Email: [email protected]
http://www.ruralcenter.org
Consultant Contact Information
Carla B. Wilber, DNP, RN, NE-BC
Stroudwater Associates
Senior Consultant Portland, ME 50 Sewall Street, Suite 102
Portland, ME 04102 (T) 207-221-8276
(C) 336-425-3837 Email: [email protected] www.stroudwater.com
Lindsay Corcoran, MHA
Stroudwater Associates
Consultant Portland, ME 50 Sewall Street, Suite 102
Portland, ME 04102 (T/F) 207-221-8262
(C) 207-939-7414 Email: [email protected] Website: www.stroudwater.com
RURAL HEALTH INNOVATIONS 9
APPENDICES
RURAL HEALTH INNOVATIONS 10
Appendix A: QI Interview schedule and First Onsite Consultation Agenda
_______ Hospital Interview Schedule
Onsite Date:
Enter names and contact information for each team member and submit to [email protected].
Time Team Members Interviewee Names Email Addresses Phone numbers
8:00 am Executive Team Interview:
CEO, CFO, COO, CNO
CEO:
CFO:
COO:
CNO:
Not applicable Not applicable
9:00 am Care Management
UR and PI/QI Department
10:00 am Nursing Clinical Leaders
11:00 am Ancillary Clinical Leaders
12:00 pm Working Lunch with Hospitalists and Primary Care Physicians and Providers
1:00 pm ED Medical Director
ED Nurse Manager
2:00 pm HIM/ Medical Records/ Coder
2:30 pm Board of Director Chair
and/or member(s)
3:00 pm
Clinic Director
Nursing Home / SNF Directors
Home Health Director
4:00 pm Consultant Prep time
4:30 pm CEO Exit interview
5:00 pm Adjournment
RURAL HEALTH INNOVATIONS 11
Appendix B: QI Project Data Request
Instructions
The CEO should submit the SRHT data request in electronic format directly to
Stroudwater Associates Senior Consultant, Carla Wilber, at
[email protected]. One designee is acceptable for submitting the hospital’s
data request. The CEO may not elect more than one representative to submit data
nor designate any other person to lead the project. SRHT Project requires the CEO
to serve as the project lead (refer to program requirements).
The data request must be completed by the SRHT defined deadline for your
hospital. SRHT Project requires data to be submitted in full by the deadline (refer to
hospital readiness). Questions regarding deadlines and/or the submission
requirements should be forwarded to Bethany Adams at [email protected].
Technical questions about the data should be forwarded to Carla Wilber at
The CEO (and the designee if chosen by the CEO) is/are responsible for tracking the
submission to ensure the quality and accuracy of the data. The designee must cc
the CEO on all data submissions when forwarding information to the
consultant.
Hospital information and data should be entered into the SRHT QI Data Request
Table below. All information that is not captured in the below table must be clearly
marked with the 1) hospital name and 2) item number to which it refers. Data
should be submit in MS Word or Excel file compatible format, when
possible. Please name each file to clearly indicate file content.
Please do not leave blanks by providing a justification for missing
information and explaining why data is not tracked. If the data is unavailable,
then provide an explanation to clarify why the information is unobtainable or
inaccessible. If the data is not tracked by the hospital, please clarify why the
information is not monitored nor trended.
Lastly, do not provide personal information such as patient names or medical record
numbers. Please review the data request prior to submission to ensure that
personal information is not included in the table and files.
RURAL HEALTH INNOVATIONS 12
_____________ Hospital Data Request Table
Hospital Name:
CEO Name:
Designee Name
Designee Title:
Designee E-mail:
Designee Phone Number:
The designee may submit data for the CEO and the hospital, but may not lead the project. Refer to the instructions above for data submission requirements.
1. Number of licensed beds ______
2. Number of staff beds ______
3. Number of distinct part unit beds by type:
_____ ICU
_____ Med Surg/Peds
_____ OB/GYN
_____ Other: Specify: ___________
4. Do you provide IP surgery? ____Yes ____ No
Specify:
5. Acute Case Mix Index: _____
6. Name of EHR system: ______
7. Percentage of physicians using CPOE: ____ %
8. Percentage of patients who were placed in the correct level of care at admissions (i.e. percent of patients that did not need to be changed from IP
to observation or observation to IP) ____ %
RURAL HEALTH INNOVATIONS 13
Hospital Name:
9. Average number of admissions by day of the week:
Sunday _____
Monday _____
Tuesday _____
Wednesday _____
Thursday _____
Friday _____
Saturday _____
10. Please provide the following data reports:
A comprehensive utilization report including payor mix for last FY and FYTD. Provide separate observation data from Acute IP data if not already part of the report.
PI/QI Core measure report for the past 2 quarters
HCAHPS report for the past 2 quarters by individual questions and
composite
Pre-determine order set such as PN, CHF, stoke and general
Last quarter PI/QI report to the board of directors (BOD)
11. IP medical coverage:
_____ Individual PCPs. How many admit? _____
_____ Hospitalist. How many hours per day do they cover? _____
_____ ED/Hospitalist model.
_____ 24/7
_____ limited hours; specify:___________
12. Do you use a formal handoff process? ____Yes ____ No
If yes, then provide a copy of the form
13. CAHs: provide percentage of All Emergency Department Transfer Communication (EDTC). _____ (%)
14. Do you track transfers? ____Yes ____ No
Do you trend transfers? ____Yes ____ No
What is your transfer rate? _____
RURAL HEALTH INNOVATIONS 14
Hospital Name:
15. Total readmission rate _____
16. Provide readmission rates for:
CHF _____
COPD _____
PNA _____
Other common readmissions: _____
17. Do you conduct post-discharge follow-up calls? ____Yes ____ No
If yes, describe the process and outcome if data is tracked.
18. IP total denial reports by payor for last FY to include the number of occurrences and dollar amounts.
19. Number of MAC/RAC chart request (Medicare) and denials over the past 12 months (if applicable)
20. Do you hold D/C planning meetings / huddles? ___ Yes ___ No
If yes, what is the frequency of the meetings / huddles? _____
If yes, who attends?
21. Please provide the following documents
D/C Planning Assessment
D/C Instruction form (general and by diagnosis if different)
Interdisciplinary Team Mtg. form
UR worksheet
Medication Reconciliation form
Discharge Instruction form
Have a folder of Patient Education documents provided for D/C ready
for consultant to review when on site
Readmission risk form
Readmission assessment form
Follow-Up call script
Organizational Chart
Orientation Plan
Annual Competency Plan for clinical staff
RURAL HEALTH INNOVATIONS 15
Hospital Name:
22. Number of clinics owned by the hospital? ____
23. Percentage of D/C to a nursing home (NH) in past six (6) months ____ %
24. Percentage of readmissions within 30 days from a NH in the past six (6) months ____ %
25. Percentage of D/C to home with Home Health (HH) in the past six (6) months ____ %
26. Percentage of readmissions within 30 days from home with HH in the past six months. ____ %
27. Provide your hospital’s logo in electronic format so that it can be included in the final report.
28. Top 10 IP bed admitting diagnoses for the past six month to include ALOS per MS-DRG with description and number of discharges excluding OB, if
offered
MS-DRG code Description Number of D/C ALOS
RURAL HEALTH INNOVATIONS 16
Hospital Name:
29. Top 10 observation admitting diagnoses for the past six months to include ALOS per MS-DRG with description and number of discharges
MS-DRG code Description Number of D/C ALOS
30. Top 10 swing bed admitting diagnoses for the past six months to include ALOS per MS-DRG with description and number of discharges
MS-DRG code Description Number of D/C ALOS
RURAL HEALTH INNOVATIONS 17
Appendix C: QI Anticipated Outcomes and Tracking Measures
Hospitals should track the below measures and report post-project values during the 12 month post-project RAP
interview. Pre-values are captured from the report and during the consultations.
Anticipated Outcome
Tracking Measure
Standard Hospital
Goal Pre-Project
Values Post-Project
Values
Improve quality of care
PPS Hospital: Improve quality of care by reducing total readmissions
CAHs: Improve quality of care by improving Emergency Department Transfer Communication (EDTC)
Acute PPS Hospitals:
total readmission rate
CMS US Reported Rates
Total ___ (%)
Total readmissions ___ (%)
Total readmissions ___ (%)
Total readmissions ___ (%)
CAHs: All EDTC (%)
State: _ (%)
National: _(%)
All EDTC __-(%)
All EDTC __-(%)
All EDTC __-(%)
Improve discharge planning processes and HCAHPS scores for
questions on discharge planning (refer to questions 19 and 20 in
Appendix D below).
HCAHPS composite scores for discharge planning as reported
in Hospital Compare or similar reporting site for item,
“Patients who reported that YES, they were given information about what to do during their recovery at
home.”
State: _ (%)
National: _(%)
___ (%) ___ (%) ___ (%)
Improve transition of care processes and HCAHPS scores for questions on Care Transition (refer Appendix D).
HCAHPS composite score for transition of care as reported in Hospital Compare or similar reporting site for item “Patients who Strongly Agree
they understood their care
when they left the hospital.”
State: _ (%)
National: _(%)
___ (%) ___ (%) ___ (%)
RURAL HEALTH INNOVATIONS 18
Appendix D: HCAHPS Survey Questions for QI SRHT Tracking
Measures
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
Survey Questions for discharge planning and transition of care.1
Discharge Planning Composite
Reported in Hospital Compare as: “Patients who reported that YES, they were given
information about what to do during their recovery at home.”
HCAHPS Question 19. During this hospital stay, did doctors, nurses or other
hospital staff talk with you about whether you would have the help you
needed when you left the hospital?
HCAHPS Question 20. During this hospital stay, did you get information in
writing about what symptoms or health problems to look out for after you left
the hospital?
Transition of Care Composite
Reported in Hospital Compare as “Patients who "Strongly Agree" they understood
their care when they left the hospital.”
HCAHPS Question 23: During this hospital stay, staff took my preferences
and those of my family or caregiver into account in deciding what my health
care needs would be when I left.
HCAHPS Question 24: When I left the hospital, I had a good understanding of
the things I was responsible for in managing my health.
HCAHPS Question 25: When I left the hospital, I clearly understood the
purpose for taking each of my medications.
1 CMS HCAHPS Survey Questions and Instructions
RURAL HEALTH INNOVATIONS 19
Appendix E: Recommendation Adoption Progress (RAP) Interview
Questions
RAP interviews are conducted at five (5) and twelve (12) months post-project. The
purpose is to assess the extent your hospital adopted consultant recommendations
over time, and determine the overall impact of the project.
Tracking measures are reported at twelve (12) months post-project prior to the
final RAP interview. Submit your hospital’s outcome worksheet with tracking
measures to Rhonda Barcus at [email protected] one (1) week prior to the
scheduled call.
1. On a scale of 1 – 5, rate the extent to which the hospital has implemented
consultant best practice recommendations.
• One (1) means that none or few consultant recommendations have
been implemented.
• Five (5) represents all are implemented, and the project is completed
and sustained with measurable outcomes.
2. What is your hospital’s current status with regard to implementing the
performance improvement recommendations made by your consultant?
Specifically, what is going well?
3. What are your expected next steps towards adopting your consultant’s
recommendations?
4. Aside from the measurable outcomes, what are some of the ways this project
has impacted your hospital, its culture and the community?
5. How do you believe this project has helped you move forward in the newly
emerging system of health care delivery and payment?
6. What additional resources or training will you need to continue to move
towards the new health care environment and become a participant in a
health care system that focuses on value, such as an Alternative Payment
Model (APM), shared savings program or patient-center medical home
(PCMH)?