Fiscal Year 2013 Medicare Rural Hospital Flexibility Program Grant Guidance Summary

Core Area 2: Support for Operational and Financial Improvement

Flex Programs are required to support efforts to improve critical access hospital (CAH) financial and operational performance improvement. Activities in this area may include: assisting CAHs in identifying potential areas of needed financial and operational improvement; supporting CAHs in planning and implementing evidence-based strategies for improving financial performance; and supporting CAHs in planning and implementing strategies for improving operational performance.

Objective 1 - Assist CAHs in identifying potential areas of financial and operational performance improvement.

Financial Indicator Reports - State Level Data|
Flex Monitoring Team
Identifies and analyzes quality, financial and community benefit indicators of critical access hospital (CAH) performance. State level data is summarized in state reports.

Nevada Rural Hospital Benchmarking Initiative
Nevada State Office of Rural Health
Represents a set of multi-year activities initiated during previous fiscal periods with the support of the Nevada Flex Program and the pooled resources of the Nevada Small Rural Hospital Improvement Grant Program (SHIP) Consortium. The five year goal of the benchmarking initiative focuses on the development and utilization of financial, operational, and quality indicators and benchmarks in all rural and frontier hospitals in Nevada.

Objective 2 - Support CAHs in planning and implementing interventions for improving financial performance. Support may include technical assistance, educational programs/seminars, user group meetings and consultation, facilitated or funded by the state Flex program. These interventions related to technical assistance applied through direct consultation.

Critical Access Hospitals and Financial Benchmark Performance
Flex Monitoring Team
Presents the results of application of the benchmarks to recent CAH data.

Managing Your Chargemaster as First Line of Defense Against Recovery Audit Contractors
WipFli
Identifies basic strategies of effective chargemaster management. Provided by Wipfli, a CPA consulting service.

Recovery Audit Program
Centers for Medicare and Medicaid
Provides information regarding the recovery audit program scope of work, appeals process, limitation on recoupment and auditor contact information.

Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
Flex Monitoring Team
Investigates how the services offered by CAHs have changed, the role of network affiliations in these changes, and the reasons administrators gave for reported service expansions.

Objective 3 - Support CAHs in planning and implementing interventions for improving operational performance. Support may include technical assistance, educational programs/seminars, user groups meetings and consultation provided, facilitated or funded by the state Flex program.

Balanced Scorecards for Small Rural Hospitals: Concept Overview and Implementation Guidance
Mountain States Group
Describes the process of implementing a Balanced Scorecard (BSC) initiative in a small rural hospital setting, including how to identify if an organization is ready for the implementation phase, what the various steps are in the process, what key principles need to be considered that are common to rural hospitals, and what a rural hospital Balanced Scorecard would look like.

Baldrige Framework Used to Address Flex Program Challenges
Nebraska Office of Rural Health
Describes how a high level of performance for most CAHs involves changing the culture of the organization, improving communication at all levels of the organization, and enhancing the processes (e.g., quality improvement and patient safety, admitting, billing and discharging patients). The Nebraska Office of Rural Health has adopted the Baldrige National Quality Model to address challenges and improve Flex Program performance.

Four Performance Management Tools: An Overview of Balanced Scorecard, Baldrige, Lean and Studer
Technical Assistance and Services Center (TASC)
Outlines performance management tools: Balanced Scorecard, Baldrige, Lean and Studer. These tools have been identified by the National Rural Health Resource Center as effective methods for managing performance improvement with small rural hospitals. Each management tool can be used independently or in combination to fit the unique challenges and culture of rural health organizations.

Health Information Technology Toolkit for Critical Access and Small Hospitals
Stratis Health
Includes several sections on project planning, issues management, workflow and process improvement, and workflow and process redesign.

New England Rural Health RoundTable Website
New England Rural Health Round Table
Provides information for critical access hospitals and other small rural hospitals on comprehensive performance improvement readiness assessments.

Workflow Assessment Toolkit
Agency for Healthcare Research and Quality
Provides information on clinical and administrativeworkflow for health information technology (HIT).Designed for people and organizations involved in the planning, design, implementation and use of HIT.

  • Objective 4 - Develop and provide the infrastructure for multi-hospital/multi-organizational collaboratives that support CAHs and other rural providers in planning and implementing evidence-based strategies for improving operational and financial performance. The collaboratives may be based on general improvement strategies, such as sharing of best practices and benchmarking, or specific improvement strategies such as revenue cycle management and departmental efficiency. The intent of the collaborative is to reduce the costs of the network members and is done by measuring profitability, liquidity, capital structure and operational ratios. Support may include technical assistance, educational programs/seminars, user group meetings and consultation, facilitated or funded by the state Flex program.

National Rural Health Resource Center1