The Flex Program in Minnesota
Medicare Rural Hospital Flexibility Program
Flex Advisory Committee
October 14, 2013
Minnesota Department of Health, Office of Rural Health and Primary Care
We’ve a successful history of working closely with our partners…
Minnesota Department of Health, Office of Rural Health and Primary Care
Goal
• Support rural communities in preserving access to
primary and emergency health care services.
Minnesota Department of Health, Office of Rural Health and Primary Care
Participation
• Federal Office of Rural Health Policy, HRSA
• 45 States receive annual federal grant funding to
administer the program
• States maintain ongoing planning and program
development activities
Minnesota Department of Health,
Office of Rural Health and Primary
Care
Administration
• State Departments
of Health
• Nonprofit
Organizations
• Universities
Minnesota Department of Health,
Office of Rural Health and Primary
Care
Key Components
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Critical Access Hospitals
Emergency Medical Services
Quality, Performance and Financial Improvement
Network Development and Enhancement
Rural Health Planning and Evaluation
Minnesota Department of Health, Office of Rural Health and Primary Care
Critical Access Hospitals
• CAH Designation Criteria
o Located in a Rural Area
o Provide 24-hour
Emergency Care
o 96-hour Average Length
of Stay
o 25 Bed Maximum
o 35 miles or less from
nearest acute care
hospital, or meet state
necessary provider
criteria
Minnesota Department of Health, Office of Rural Health and Primary Care
Critical Access Hospitals
• Currently 79 CAHs in Minnesota
• “Necessary Provider” sunset 1/1/2006
Minnesota Department of Health, Office of Rural Health and Primary Care
Critical Access Hospitals
• Benefits
o Medicare cost-based reimbursement - currently
at 101% of reasonable costs
o Exempt from inpatient and outpatient
prospective payment systems
o Capital improvement and equipment costs may
be included in the Medicare cost report
o May establish psych and rehab distinct part units
up to 10 beds each
o DPU beds are paid under prospective payment
system
Minnesota Department of Health,
Office of Rural Health and Primary
Care
Critical Access Hospitals
• Issues
o Community
development
o EMS integration
o Workforce
o Evaluation
o Access to
capital
Minnesota Department of Health, Office of Rural Health and Primary Care
Minnesota Department of Health, Office of Rural Health and Primary Care
Emergency Medical Services
• Training initiatives
• Encouraging
local
collaboration
• Enhancing data
collection and
reporting
• Workforce
projects
• MN State Trauma
Designation
Minnesota Department of Health, Office of Rural Health and Primary Care
Quality Improvement
• Improve QI through technical assistance and
financial support
• Development of networks and affiliations
• Connecting hospitals and providers with resources
for QI
• CAHs required to have agreement with network
hospital, QIO or other qualified entity for QA and
credentialing
• MBQIP—Medicare Beneficiary Quality Improvement
Program
Minnesota Department of Health, Office of Rural Health and Primary Care
Quality Improvement
• CAH and EMS initiatives
o Training & education
o Medical error reporting
o Data feedback
o Staffing
o Use of protocols
o Error prevention systems
o Link with MN Hospital Association, Stratis Health
Care, Network Hospital, EMS Organizations,
Public Health
Minnesota Department of Health, Office of Rural Health and Primary Care
Networks
• Patient referral and
transfer agreements
• Use of
communications
systems for sharing
patient data and
telemetry
• QI activities
• Specialty services
• Transportation
• Credentialing
• Health Information
Technology
Minnesota Department of Health, Office of Rural Health and Primary Care
Planning and Evaluation
• Rural Health Plan:
o Improve access to hospital and other health
services for rural residents
o Promote regionalization of rural health services
o Support rural health networks among CAHs and
acute care hospitals
Minnesota Department of Health, Office of Rural Health and Primary Care
Evaluation
•
Flex Program Monitoring Team
o University of Minnesota
o University of North Carolina
o University of Southern Maine
• www.flexmonitoring.org
•
TASC - assists with dissemination
• www.ruralcenter.org/tasc
Minnesota Department of Health, Office of Rural Health and Primary Care
Flex Monitoring Team
• Financial Indicators Reports
• Quality Improvement Reports
• Report on the Flex Program at 10 Years
Minnesota Department of Health, Office of Rural Health and Primary Care
TASC
Rural Health
Resource Center
TASC supports all 45 state Flex
programs to:
• Integrate EMS into rural
medical delivery systems
• Build rural hospital
networks
• Obtain economies of
scale and increase cost
efficiency and overall
effectiveness
• Improve quality and
overall organizational
performance
Minnesota Department of Health, Office of Rural Health and Primary Care
Flex Advisory Committee
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•
•
•
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•
•
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10 CAH CEO’s
Minnesota Hospital Association
Stratis Health
EMSRB
MDH Compliance Monitoring
Minnesota Ambulance
Association
Rural Health Advisory
Committee
Rural Health Clinic
Minnesota Rural Health
Association
•
•
•
•
•
•
•
•
Rural Health Resource Center
Physician Extender
Rural Physician or Director of
Nursing
Financial Services
Rural Regional EMS
Organization
Two at large members
MN Department of Human
Services
Congressional offices (nonvoting)
Minnesota Department of Health, Office of Rural Health and Primary Care
Staffing
• Judy Bergh, Flex Coordinator
• Craig Baarson, Reimbursement Analyst
• Anne Schloegel, Quality Improvement
• Tim Held and Mark Schoenbaum, Administration
• Cindy LaMere, Administrative Support
• Kristen Tharaldson, RHAC Coordinator
And all the talented staff of the Office of Rural Health
and Primary Care!
Minnesota Department of Health, Office of Rural Health and Primary Care
Financial History
Minnesota Flex Program Budgets 1999--2013
1999
0
2000
0
2001
0
2002
0
2003
0
2004
0
2005
0
2006
0
2007
0
2008
0
2009
22,000
2010
15,000
2011
10,000
2012
0
2013
0
300,000
na
150,000
100,000
24,000
35,000
0
0
0
0
0
0
0
0
0
CALS
0
na
0
50,000
50,000
50,000
49,250
45,000
50,000
50,000
50,000
50,000
50,000
55,000
50,000
Competitive Grants
0
na
195,000
220,000
240,000
247,000
225,000
225,000
150,000
175,000
175,000
215,000
249,000
254,800
254,800
EMSRB and/or EMS
20,000
na
0
25,000
22,000
25,000
23,000
28,000
100,000
78,880
60,000
0
0
0
14,000
Evaluation
40,000
na
20,000
0
0
0
6,500
5,000
20,000
14,790
15,000
15,000
12,000
12,000
0
0
na
0
0
0
0
20,000
0
0
0
5,000
0
0
0
0
20,000
na
20,000
15,000
13,000
10,000
14,000
30,000
30,000
34,510
35,000
45,000
45,000
45,000
40,000
0
na
100,000
40,000
0
30,000
48,000
40,000
0
0
0
0
0
0
0
10,000
na
10,000
0
0
0
0
0
0
0
0
0
0
0
0
Rural Health Conference
0
na
0
0
0
0
0
10,000
10,000
9,860
10,000
15,000
15,000
15,000
10,000
Rural Health
Works/RHRC
0
na
0
20,000
20,000
20,000
10,000
0
0
0
0
0
0
0
0
Stratis Health
0
na
0
0
50,000
47,000
25,000
50,000
50,000
50,000
50,000
70,000
76,000
70,000
60,000
Training Contracts
0
na
0
0
0
3,000
5,000
8,000
5,000
0
0
0
0
0
0
ACS/ATLS Courses
CAH Conversion Grants
LTC Projects
MHA
Network Grants
Research Consultant
0
na
0
0
0
0
0
0
15,000
0
0
60,000
35,000
35,000
34,000
Total grants and contracts
390,000
na
495,000
470,000
419,000
467,000
425,750
441,000
430,000
413,040
422,000
485,000
492,000
486,800
462,800
Total Federal Funding
600,000
na
700,000
700,000
685,000
685,000
625,000
650,000
650,000
640,900
656,413
730,183
736,183
730,183
699,949
ORHPC admin. costs, e.g.,
staff, travel, meeting expense,
supplies, indirect, etc.
210,000
na
205,000
230,000
266,000
218,000
199,250
209,000
220,000
227,860
234,413
245,183
244,183
243,383
237,149
Trauma System
Consultation or RTAC
Grants
Minnesota Department of Health ,Office of Rural Health and Primary Care
Current Five Year Plan
September 1, 2015—August 31, 2014
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•
Flex Year 15—Year 4 of 5 year
grant period
Priority Areas
o Quality Improvement
o Financial and Operational
Improvement
o Community Engagement
Minnesota Department of Health, Office of Rural Health and Primary Care
Flex Program Objectives: QI
Support CAHs to:
•
•
•
•
Publicly report to Hospital
Compare and HCAHPS (MBQIP)
•
Participate in QI training for
staff and board members
Participate in multi-hospital QI
project
•
Obtain needed TA related to
HIT
•
Develop HIT Infrastructure
•
Train clinicians and staff in
meaningful use
Participate in quality and
benchmark reporting other
than MBQIP
Participate in patient safety
project focused on leadership
and organizational culture
Minnesota Department of Health, Office of Rural Health and Primary Care
Flex Program Objectives: FI and PI
•
Assist CAHs in identifying opportunities for financial and performance
improvement
•
Support CAHs in planning and implementing evidence based
strategies for improving financial performance
•
Support CAHs in planning and implementing evidence-based
strategies for improving operational performance
•
Develop and provide infrastructure for multi-hospital collaborative
that supports CAHs in financial and operational improvement
Minnesota Department of Health, Office of Rural Health and Primary Care
Flex Program Objectives: Health System Development
and Community Engagement
•
Support CAHs, communities, rural and urban hospitals, EMS, and
other providers in developing local and/or regional systems of care
•
Support the inclusion of EMS services into local and/or regional state
trauma system
•
Support CAHs and communities in conducting or collaborating on
assessments to identify unmet community health and health service
needs
•
Support CAHs and communities in developing collaborative projects
or initiatives to address unmet community health and health service
needs.
Minnesota Department of Health, Office of Rural Health and Primary Care
And we’re still partners after all this time…still experiencing success…
…and looking forward to even more successful
partnerships and proud accomplishments!
Minnesota Department of Health, Office of Rural Health and Primary Care