Hospital State Division Kristi Martinsen Hospital State Division Director HSD Overview September 2013 Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy

Hospital State Division - Regional Liaisons Dan Mareck Keith Midberry E David Dietz Megan Meacham C Jeanene Meyers Natassja Manzanero A Steve Hirsch D Bridget Ware Sarah Young B

Hospital State Division ORHP Project Officers TA Partners (NOSORH, TASC, FMT) Grantees Collaborative Partnership

Office of Rural Health Policy (ORHP) Activities Improving Rural Health Initiative “Within the total amount requested for Rural Health Activities, the Budget includes $79 million to continue the President’s initiative to improve rural health. The goal of this initiative is to improve the access to and quality of health care in rural areas.”

Office of Rural Health Policy (ORHP) Activities Improving Rural Health Initiative: Key Elements Building a Programmatic “Evidence Base”Health Workforce Recruitment & RetentionTelehealth/ HIT CoordinationCross Governmental Collaboration

Hospital State Division (HSD) Overview Measuring and Improving Outcomes Using and Sharing the Program Data Collaborating and Sharing Best Practices Aligning Programs to the Health Care Environment Program Integrity Grants State Offices of Rural Health (SORH) Medicare Rural Hospital Flexibility Program (FLEX) Small Hospital Improvement Program (SHIP) Initiatives Flex Medicare Beneficiary Quality Improvement Project (MBQIP) Delta Rural Hospital Performance Improvement Project (RHPI) Focus Programs

Hospital State Division (HSD) Grants: State Offices of Rural Health (SORH) State / Federal partnership assist States in strengthening rural health care delivery systems Establish & maintain clearinghouse Coordinate activities within state to avoid duplication of effort & activities. Provide technical assistance Encourage recruitment & retention of health professionals FY 13 grant guidance competitive New 3 year project period Submit via Grants.gov Focus on key SORH activities for all 50 states Purpose Awards

Hospital State Division (HSD) SORH Grant TA Partners National Organization of State Offices of Rural Health Provide education, resources and TA to State SORH Programs

NeedAssessmentActivitiesMeasuresOutcomes Grantee (State) Process Program (National) Context Hospital State Division (HSD) Grants: Outcomes Focus – Quality and Performance Improvement Hospital Level State Program Level National Program Level Determine Effective Interventions Refine Flex Program Activities

Hospital State Division (HSD) Grants: Small Rural Hospital Improvement Program (SHIP) Encouraging Networking Strategically Using Grant Dollars Updated SHIP Categories Aligned to Affordable Care Act ICD 10 Updates: Competitive in FY 13: Awards coming out any day for 9/1 start date **In 2016 will change to a 6/1 start date Anticipated amount of award: ~ $8800 per hospital FY13 SHIP Focus: MBQIP Activities (Inpatient and HCAHPS) ICD-10 Innovations group for health IT projects and community-based interventions Purpose Awards

Hospital State Division (HSD) SHIP Grant TA Partners Technical Assistance and Services Center Provide education, resources and TA to State SHIP Programs

Hospital State Division (HSD) Four Core Focus Areas: Grants: Medicare Rural Hospital Flexibility Program (FLEX) Support for Quality Improvement in CAHs Support for Operational & Financial Improvement in CAHs Support for Health System Development and Community Engagement Including integrating EMS in regional and local systems of care Designation of CAHs in the State

Flex In Motion Need Assessment ActivitiesMeasures Outcomes

Hospital State Division (HSD) Flex Grant TA Partners Technical Assistance and Services Center Provide education, resources and TA to State Flex Programs and CAHs Flex Monitoring Team CAH Financial Indicator Reports State Hospital Compare & Quality Measure Reports Other briefs & reports yearly on quality, finance, and community engagement

Pilot project focusing upon quality improvement and data reporting Common clinical and process metrics (i.e., syncing with NQF and Hospital Compare) Measuring outcomes and demonstrating improvements via evidence-based practices Sharing evidence-based practices Medicare Beneficiary Quality Improvement Project (MBQIP)

Hospital State Division (HSD) Medicare Beneficiary Quality Improvement Project (MBQIP) Total CAHs CAHs participating % participation % Goal: 100% Reporting on Rural-Relevant and Common National Measures Measuring Outcomes and Demonstrating Improvements Sharing Best Practices

Hospital State Division (HSD) Medicare Beneficiary Quality Improvement Project (MBQIP) Pneumonia: Hospital Compare CMS Core Measure (participate in all sub-measures); AND Congestive Heart Failure: Hospital Compare CMS Core Measure (participate in all sub-measures) Phase 1 Measures (Begin September 2011) Outpatient 1-7: Hospital Compare CMS Measure (all sub- measures that apply); AND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Phase 2 Measures (Begin September 2012) Pharmacist CPOE/Verification of Medication Orders Within 24 Hours; AND Outpatient Emergency Department Transfer Communication *Reporting tool for Phase 3 Measures is yet to be determined Phase 3 Measures * (Begin September 2013)

Health Reform Initiatives Reduce harm caused to patients in hospitals. We will accelerate the reduction of preventable harms to inpatients starting now, so that by the end of 2013 we will observe a 40% reduction in preventable harm compared to Based on our calculations, this would mean almost two million fewer injuries to patients and more than 60,000 lives saved. Reduce preventable hospital readmissions. We will advance efforts to decrease preventable hospital readmissions within 30 days of discharge, so that by 2013 all readmissions would be reduced by 20% compared to This would mean prevention of more than 1,600,000 hospital readmissions. Achieving these two goals will not only save lives and greatly reduce injuries to millions of Americans, it will also result in savings of billions of dollars that help put the nation on the path to having a more sustainable health care system. Partnership for Patients

White House Rural Council Expand NHSC to CAHs Began in clinicians receiving repayment (July) 34 clinicians applied for repayment (July) Promote HIT in Rural Areas Collaboration with USDA Access to Capital Rural HIT Workforce Training

Office of Rural Health Policy (ORHP) Activities White House Rural Council Access to Capital Workgroup August 2012 Brought together federal partners and rural stakeholders to discuss challenges and opportunities Upcoming resource guide for SORHs and rural hospitals on capital resources

Resources Workforce: Linking Rural Health Care Providers to the Federal Workforce Programs HRSA Programs such as... National Health Service Corps Nursing Loan Repayment Primary Care Training Nursing Education Key Challenge: Linking Providers & Educational Institutions pdf/ruralhealthfundingguidance. pdf

ORHP Affordable Care Act Activities Weekly Office Hour Calls Wednesdays, 3-4 pm Eastern Time Call-in Number: (800) ; Passcode: ORHPACA Adobe Connect Session: 6/13 Topic: ACA 101ACA 101 6/27 Topic: ACA Medicaid Expansion 101ACA Medicaid Expansion 101 7/10 Topic: Consumer AssistanceConsumer Assistance 7/17 Topic: SHOPs, Tax Credits/Subsidies, and the Unbanked Population SHOPs, Tax Credits/Subsidies, and the Unbanked Population 7/24 Topic: Minimum Coverage Provision, Exemptions, Subsidies and Dual EligiblesMinimum Coverage Provision, Exemptions, Subsidies and Dual Eligibles 7/31 Topic: Consumer AssistanceConsumer Assistance Questions and Distribution List this address with any questions and if you want to be added to the ORHP distribution list for s on resources and call

Ask Insurance Commissioners/Marketplace which Qualified Health Plans (QHP) are participating. Inform QHPs if you are an Essential Community Provider. Begin negotiating contracts with QHPs. Educate QHPs about your role in rural communities. Refer patients to Healthcare.gov. Talk to your patients about their eligibility and enrollment options. Refer patients to Consumer Assistance Programs in your state. What kind of Marketplace does your state have? What rural providers need to know about the Health Insurance Marketplaces: STEP 1: STEP 2: STEP 3: STEP 4: How many uninsured individuals are in your area?

Contact Information Kristi Martinsen Hospital State Division Director