1. Montana Rural Hospital Flexibility and Rural Healthcare Performance Improvement Network Orientation Program June 2011

2. Some common acronyms… Flex = Rural Hospital Flexibility Program PIN = Performance Improvement Network DPHHS = MT Dept of Public Health and Human Services MHREF = MT Health Research and Education Foundation, the not-for-profit arm of MHA MHA = MT Hospital Association

3. Some common acronyms… CAH = Critical Access Hospital QI = Quality Improvement PI = Performance Improvement CMS = Centers for Medicare and Medicaid Services

4. Montana’s Flex Program  MT Grantee = DPHHS Quality Assurance Division Jeff Buska, Administrator Kathy Lubke, Program Officer  DPHHS contracts with MHREF to administer Flex funded activities  DPHHS retains program evaluation and fiscal management responsibilities Flex grant year runs from September 1 thru August 31

5. Flex/PIN Staff Flex Director Carol Bischoff457-8016carol@mtha.orgcarol@mtha.org Rural Hospital Quality Coordinator Kathy Wilcox461-6186kathy@mtha.orgkathy@mtha.org

6.  St. John’s Lutheran Hospital  Clark Fork Valley Hospital  Mineral Community Hospital  Marias Medical Center  Liberty Medical Center  Pondera Medical Center  Teton Medical Center  Missouri River Med. Center  Big Sandy Med. Center  Powell Co. Medical Center Granite Co. Medical Center   Ruby Valley Hospital  Barrett Memorial Hospital  Mountainview Medical Center  Livingston Healthcare  Pioneer Medical Center  Stillwater Comm. Hospital  Beartooth Hosp. & Health Center  Rosebud Health Care Center  Dahl Memorial Healthcare Assoc.  Fallon Medical Complex  Prairie Community Hospital  Garfield Co. Health Center  McCone Co. Health Center  Roosevelt Med. Center  Poplar Comm. Hospital  Sheridan Memorial Hosp.  Frances Mahon Deac. Hospital  Phillips County Hospital  Wheatland Memorial Healthcare Montana Critical Access Hospital Program Status June 2011  Critical Access Hospitals Potential Critical Access Hospital  Broadwater Health Center  Madison Valley Hospital  St. Luke Comm. Hospital  Glendive Medical Ctr  Big Horn County Memorial Hospital  St. Joseph Hospital  Community Hospital of Anaconda Marcus Daly Memorial Hospital   North Valley Hospital  Northern Rockies Medical Center  Daniels Memorial Healthcare Center NE MT Health Services  Fort Belknap Service Unit  Crow/N. Cheyenne Indian Hospital  Roundup Memorial Healthcare  Sidney Health Center Blackfeet Comm. Hospital  Central Montana Medical Center  Holy Rosary Healthcare

7. Flex Grant Core Areas 2010-2011 Quality Improvement Operational and Financial Improvement Health System Development and Community Engagement

8. Flex Grant Activity Sampler Core activities QA/QI/PI: CoP assistance and other quality based projects: benchmarking, clinical improvement & benchmarking, quality education & support network Meetings: CEO x 2, DON Forum, QI Showcase, Champions for Quality, Regional QIC/DON Coding workshops Other projects vary from year to year CAH CFO networking options HIT web-based resource book Facility specific economic impact reports Cost report review Leadership Institute Lean internships PIN website THE LIST IS ALMOST ENDLESS!

9. Continue Clinical Improvement Studies (CIS) CIS Lunchtime Learning CAH Peer review Credentialing education Benchmarking/Clinical benchmarking Networking Meetings PIN website PI/QA/QI Education and resources Prevent Transmission of MRSA collaborative w/ QIO, DPHHS Maintain HIT website HIT Training Goal #1-Support efforts to improve and sustain quality of care

10. Precursor to value-based purchasing for CAHs? Phase 1 Measures (one-year time frame 2011-2012) Pneumonia: Hospital Compare CMS Core Measures Congestive Heart Failure: Hospital Compare CMS Core Measures Phase 2 Measures (one-year time frame 2012-2013) Outpatient 1-7 as specified in Hospital Compare (AMI-ED, SCIP) Hospital Consumer Assessment of Healthcare Providers and Systems Phase 3 Measures (one-year time frame 2013-2014) Pharmacist Review of Orders Outpatient Emergency Department Transfer Communication The Flex Medicare Beneficiary QI Project …aka MBQIP!

11. Meetings: Administrator, Nursing Directors Coding workshops CFO Networking Medical necessity determination (RAC) Explore capital funding options Leadership Institute Lean internships Goal #2- Support efforts to improve Montana CAH financial and operational performance

12. GEMS-Geriatric Emergency Medical Services CHSD-Community Health Services Development Year 5-Needs assessment and community health care planning Fallon Medical Center in Baker, Madison Valley Hospital in Ennis, Holy Rosary in Miles City, Dahl Memorial in Ekalaka, Rosebud Health Care Center in Forsyth, Prairie Community in Terry and Clark Fork Valley Hospital in Plains MT Rural Health Plan Goal #3- Support efforts to assist CAHs in developing systems of care, addressing community needs

13. Flex Networking/Ed Activities 2010-2011 Champions for Quality 2011 “Back to the Future” July 14-16, 2010 Great Northern Hotel Helena Medical Education, CMEs, Nursing CE credits 100% say this conference is worth their time to attend! Lunchtime Learning: another opportunity for provider education

14. Flex Networking/Ed Activities 2011 CAH AdministratorsBillingsSept 21, 2011 Joint QI Coordinators & DONs Regional Meetings Oct 2011; dates & locations to be announced CAH AdministratorsJan 2012 DON ForumMarch 2012 QI Showcase, FairmontApril 2012

15. Flex Networking/Ed Activities 2010-2011 Coding workshops: 5 th year! CFO Networking: ListServe; HFMA attendance Credentialing: MTAMSS Conference June 2011

16. Sustainable Leadership 2010-2011 Leadership Institute Lean Process Management North Valley Hospital, Whitefish Northern Rockies, Cut Bank Broadwater Health Center, Townsend McCone County Health Center, Circle Rosebud Health Care Center, Forsyth Fallon Medical Center, Baker

17. Flex HIT Support Activities 2010-2011 HIT Technical Assistance website www.mtpin.orgwww.mtpin.org HIT Resource Guide Username MT CAH48 Password HIT Resource HIT Education Programs HIT Certification Program- MT Tech, Butte IT/HIT Literacy- Helena College Of Technology

18. Significant Flex resources support the Montana Rural Healthcare Performance Improvement Network (PIN)

19. Performance Improvement Network Formed at request of CAH CEOs in 2001 All 48 MT CAHs are members Governance provided by PIN Advisory Board up to 10 members: CEOs, DONs, QI/PI Clinical oversight provided by the Clinical Improvement Panel (CIP)

20. Performance Improvement (PI) Program C-0191Agreements with qualified entities C-0195Agreements for Credentialing and Quality Assurance C-0271Clinical policies and procedures

21. Performance Improvement (PI) Program C-0330“Periodic Evaluation”, ie, the Annual CAH Program Evaluation C-0336“An effective QA program”: the expectation of measurable improvement C-0337All patient care and other services affecting patient health and safety are evaluated

22. Performance Improvement (PI) Program C-0338Includes nosocomial infections and medication therapy C-0339Includes quality and appropriateness of diagnosis and treatment (ie, “peer review”) C-0341Considers findings and recommendations from the QIO and takes corrective action C-0342Takes appropriate remedial action to address deficiencies found through the QA program (ie, CAH survey deficiencies)

23. Performance Improvement (PI) Program Provides support for in-house PI staff Opportunities for improving performance Clinical improvement studies, clinical benchmarking Education, training and PI resources PIN Education Committee Regulatory information and support (CMS) Tag by tag review; fourth Wed each month, 2 pm

24. Performance Improvement (PI) Program Support for in-house staff, cont. Consultation onsite as requested – Networking opportunities sponsored meetings Engaging administration and medical staff Administrator meetings; Champions for Quality; clinical improvement panel and studies

25. Facility Staff Support Resources “Best Practice” tools, resources and education PIN ListServ pin@astro.lyris.netpin@astro.lyris.net Quarterly PIN newsletter PIN website www.mtpin.orgwww.mtpin.org

26. 11 years in the development 13 indicators initially; 25 currently 94% reporting rate in 1st quarter 2011 Continually refining metrics & peer groups PIN Benchmarking Project

27. Sample report 8 quarters 5 Peer Groups

28. Clinical Improvement Studies Program Clinical Improvement Studies (CIS) 2 studies underway at all times Clinical Improvement Panel (CIP) 8 PIN Physician volunteers 2 PIN mid-level volunteers CIS Development Committee (CIS-DC) DON and QI/PI Coordinator volunteers

29. CIS Program 2011 Patient Safety: Prevent MRSA Transmission Pediatric Emergency Care: completed May 2011 Clinical Benchmarking Project Pressure Ulcers, HF, CAP, Stroke, Inter-facility Transfer measures, Reduce Preventable Falls Quality Awards: 2011 recipient criteria Applications due August 1, 2011 You MUST apply to receive an award!

30. PIN Lessons Learned Leadership commitment is essential Involve more than CEOs Clarifying program responsibility and accountabilities in the facility are essential (not just the coordinator) Frequent communication “What gets measured gets managed”

31. QUESTIONS? Cultural transformation is a slow, deliberate, strategic process.