1. Housekeeping

2. Medicare Beneficiary Quality Improvement Program (MBQIP)
Stephen Njenga, Director of Performance Measurement Compliance
August 8, 2017

4. Financial and Operational
FLEX Grant Activities
Patient safety, patient engagement, care transitions, outpatient care
Quality
Financial and operational assessments and actions, revenue cycle management, operational improvement
Financial and Operational
Identify specific health needs of CAH communities and implement activities
Population Health
Dana- These are the categories included in the FLEX grant for The sections include quality, financial and operational and population health. In the Quality section, we collect data on patient safety, patient engagement, care transitions and outpatient care in order to find our gaps and work to improve processes. Quality of care in our small communities is very important to the reputation and financial viability of the hospital.
In the financial and operational section, our technical support and resources are aimed at financial and operational assessments and actions, revenue cycle management and operational improvement. MHA strives to provide generalized support, to all participating hospitals, as well as individualized support to six hospitals identified as financially-distressed.
In population health, we are focused on assisting our hospitals in identifying specific health needs of their communities and how to implement activities.

5. 61% OF Missouri CAH’s are currently submitting their HCAHPS data through 4Q2016.

8. New Reporting Requirements for FY2018-2021

9. ED Throughput Measures
Proposed additions to MBQIP FY (September 2018 – August 2022)
ED-1 – Median Time from ED Arrival to ED Departure for Admitted ED Patients
ED-2 – Admit Decision Time to ED Departure Time for Admitted Patients
The Federal Office of Rural Health Policy (FORHP) is considering the addition of two CMS Hospital Compare Measures as core measure requirements for the Medicare Beneficiary Quality Improvement Project (MBQIP) for the next Medicare Rural Hospital Flexibility (Flex) grant program project period FY18 – 21 (September 2018 – August 2022):
Considered ED Throughput measures, ED-1 and ED-2 have been included as optional measures in the Outpatient MBQIP Domain since FY 2015, and in calendar year 2015 more than 40% of CAHs nationally reported both measures. The measures are chart-abstracted, and reported to QualityNet quarterly via CART or a vendor tool.
These metrics help continue to focus improvement efforts on timeliness of care in the ED, and incorporate communication and alignment of processes with inpatient units for timely transfer of patients to an inpatient bed once an admit decision has been made.
CMS considers ED-1 and ED-2 to be Inpatient measures, since the population for the measures is patients with an inpatient stay. MBQIP has included them in the Outpatient measure domain since they more closely align with ED/outpatient processes.

10. 17 CAH’s are already reporting these ED Throughput measures.

11. Antibiotic Stewardship
This addition would allow critical access hospitals (CAHs) four years to fully implement an antibiotic stewardship program by the end of FY (September 1, August 31, 2022)
Leadership Commitment 
Accountability
Drug Expertise
Action
Tracking
Reporting
Education
Improving antibiotic use in hospitals is imperative to improving patient outcomes, decreasing antibiotic resistance, and reducing healthcare costs. According to the Centers for Disease Control and Prevention (CDC), 20-50% of all antibiotics prescribed in U.S. acute care hospital are either unnecessary or inappropriate, which leads to serious side effects such as adverse drug reactions and Clostridium difficile infection. Overexposure to antibiotics also contributes to antibiotic resistance, making antibiotics less effective.
Summary of Core Elements of Hospital Antibiotic Stewardship Programs
Leadership Commitment: Dedicating necessary human, financial and information technology  resources 
Accountability: Appointing a single leader responsible for program outcomes.  Experience with successful programs show that a physician leader is effective
Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use.
Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours)
Tracking:  Monitoring antibiotic prescribing and resistance patterns
Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff
Education: Educating clinicians about resistance and optimal prescribing

12. Poll Question # 1

13. Requirements on the Horizon – HAI Measures
Proposed additions to MBQIP FY (September 2018 – August 2022)
HAI – 2 CAUTI (Catheter Associated Urinary Tract Infection)*
HAI – 5 MRSA (Methicillin-Resistant Staphylococcus Aureus Infections)*
HAI – 6 CDI (Clostridium Difficile Infections, C. diff)*
The Federal Office of Rural Health Policy (FORHP) is considering the addition of three CMS Hospital Compare Measures related to Hospital Acquired Infections (HAI) as core measure requirements for the Medicare Beneficiary Quality Improvement Project (MBQIP) for the next Medicare Rural Hospital Flexibility (Flex) grant program project period Fiscal Year (FY) 2018 – 2021 (September 2018 – August 2022):
Prevention of HAIs is an important public health and patient safety issue, and CAHs need to show active engagement in addressing this challenge. To support successful implementation FORHP is developing a partnership with CDC to help ensure useful data and resources are available to Flex programs to support HAI data collection and improvement efforts.
The publically reported measure for these HAIs is a Standardized Infection Ratio (SIR). SIRs are calculated by CDC, and are risk adjusted for facility and patient characteristics. The SIR compares the number of reported HAIs to the number of predicted HAIs (OBSERVED/PREDICTED = SIR). Hospitals that have less than one (1) predicted HAI in a given timeframe do not have a SIR calculated. Most CAHs fall into this category, and few CAHs will have a SIR calculated for any of the HAIs in a single quarter.
*These measures did not go through based on feedback received from CAHs, but it is recommended hospitals keep track of them as they currently are under the optional measures category.

14. Poll Question #2

15. Data Analytics – Current Trends

25. Emergency Department Transfer Communication — EDTC

32. Resources

36. Upcoming Events
Missouri Rural Health Conference — FLEX Statewide Meeting, August 15-17
Population Health Webinar
10 a.m. Tuesday, August 22
Fall Regional Meetings
October 5 — Clinton
October 11 — Chillicothe
October 18 — Festus
Please visit our website for registration links.

38. References MHA http://web.mhanet.com/mbqip.aspx
QualityNet
Hospital Compare ch.html
National Rural Health Resource Center

39. Stephen Njenga, MPH, MHA, CPHQ, CPPS
Director of Performance Measurement Compliance
Missouri Hospital Association
573/ , ext. 1325
Here is my contact information.