Critical Access Hospital and Medicare Rural Hospital Flexibility Program Pre-Conference Workshop. Tuesday, February 18, 2003

Transcription

1 Critical Access Hospital and Medicare Rural Hospital Flexibility Program Pre-Conference Workshop Tuesday, February 18, 2003 Brad Gibbens, MPA, Associate Director Website: Where: Grand Forks, ND When: Established over 20 years ago Focused on Access, Financing and Quality Through: ØHealth services research ØHealth policy ØEducation ØState and community health services development ØInformation Resource How: Through partnerships 1

2 Today s Focus! Technical Assistance and Grants! FLEX Grant Writing Tips! Hospital Networking: Where are We and Where Do We Go? Key to Our Success as a State and Program! YOUR INPUT, IDEAS, DIRECTION Technical Assistance! What does the FLEX program offer to North Dakota s rural hospitals? " Community Assessments " Strategic Planning " Focus Groups " Community Forums " Internal Personnel Audits " Workshop Development " Grant Development " Community Education " CAH Clearinghouse (access to AHA, TASC, FLEX Tracking Program) 2

3 Technical Assistance o CAH Financial Clearinghouse (NDHA) o Claims Data Analysis (NDHD) o Special Studies o Rural Hospital List Serv! FLEX Update! Communication FLEX Grants CAH Program Grant! Categories " Financial Analysis/Assessments Up to $10,000 for any eligible hospital One pre-cah analysis per hospital " Other Financial Analysis Analyze post-cah conversion reimbursement Chargemaster review (one per hospital and capped) Regulatory change (impact of increased reliance on nonphysician provider, etc.) Outpatient reimbursement changes Service development/diversification feasibility studies Clinic/outpatient services review and comparisons (e.g., RHC, FQHC, CAH/FQHC integration, etc.) Other ideas 3

4 FLEX Grants CAH Program Grant (continued)! Network Development " No dollar cap " Must be a CAH or actively involved in seeking CAH status " Service diversification + Cardiac Rehab + Pulmonary Rehab + EMS + Physical therapy + Surgery + Tele-radiology + Urgent care + Wellness program + Training/education " System Stability + Consultant assistance + Legal assistance + Communication systems + Community Education (Polycom system) + Quality Improvement + Staff Recruitment and Retention + Telemedicine FLEX Grants CAH Program Grant (continued)! Local Health Task Force Development " No dollar cap " Must be a CAH or actively involved in seeking CAH status " Cannot pay for food/beverages out of the federal funds " Avoid travel costs " Can pay for presenters/speakers/ experts to come to your town " Promotional costs " Ideas + Workforce Task Force (R/R Committee) + Citizens to Save/Support the XYZ Hospital + Regional Task Force for Area Health Services (other towns) " Task Force can build community involvement, community support, regional awareness and support, and visibility 4

5 FLEX Grants EMS Network Grant! Purpose is to establish an EMS network and collaborative relationships between the CAH and EMS.! The network will consist of, at a minimum, one CAH and two certified ambulance units.! The applicant must be the CAH and the CAH assumes fiscal responsibility for the project funds.! Capped at $15,000 FLEX Grants EMS Network Grant (continued)! Networks have been addressing the following " Regional Mass Casualty Incident Protocol and Operating Plan " EMS equipment (AEDs, mannequins, software) " EMS training (ACLS, PALS, EMS-C) " Marketing " Recruitment/retention 5

6 FLEX Grants Network Enhancement Grant! Network Enhancement Grants are the new focus of the program.! Eligible networks: at a minimum, one CAH and one other separate legal entity.! CAH is the applicant but represents the network.! Requires a detailed MOA.! Requires a strong budget narrative (detail).! Describe how the network facilitates a collaborative relationship between the partners (and also present role/responsibility in the MOA). FLEX Grants Network Enhancement Grant! Funded networks: " Quality Improvement (Mayville) " Shared Service Network (planning) " Provider Network (planning and assessment) " Cardiac Emergency Network 6

7 FLEX Grant Writing Tips! Environment is changing " More competition " Need to be clearer in establishing problem and solutions. " Proposals need to be more compelling and persuasive. " Take adequate time to think through and research your proposal. " States feel more direction from funders to focus on network activities. FLEX Grant Writing Tips " There is a need to be more global + Think collaboratively (partnerships and networks) how can I pull into the mix more partners? + Think strategically toward the future how can I link together different grants? (FLEX grant leading to an Outreach grant and/or a federal Network Development grant). + Think development and long term shared program diversification, shared staff training, shared community education, shared recruitment/retention, and less equipment. 7

8 FLEX Grant Writing Tips! Each of the three grant areas has specific questions that need supporting evidence! All require a section on needs " What is the problem? How do you substantiate the claim? (evidence) F Document that 40, 80, or 120 people leave the area for services elsewhere and what the implication of that loss is to the hospital. F Document that the Medicare or Medicaid population travels 200 miles to receive care in a tertiary facility twice a month. Cost. FLEX Grant Writing Tips F Make use of statistics, data, and resource information: Use statistics on health status (how does your service area compare with the state and national average.) Contact the Center, health department, hospital association for information or referrals to other sources. Contact RAC. Hospital presented DRG data associated with yearly procedures and age adjusted death rates to support argument for COPD services. 8

9 FLEX Grant Writing Tips Needs section (continued) Document requests for new or replacement equipment based on how the equipment addresses specific needs and services. How does the equipment request meet patient needs? How old is the present equipment and what is its average life span? But do not base the request entirely on the fact that the equipment is old. Do not assemble an equipment wish list that is not connected to patient care, program development, program diversification. If it is a network grant how does the equipment benefit all the members. Use statistics from reliable sources and cite and date the information. If not cited, the reviewer does not know if they are credible citations and how old they may be. FLEX Grant Writing Tips! All proposals need to answer the tough question? So what? How does this request help access to care? How does it address patient care and services?! Explain concepts thoroughly. Do not assume the reviewer understands everything you know about hospitals. Better too much detail than not enough.! Provide adequate information about the community and service area. 9

10 FLEX Grant Writing Tips! Provide adequate information on the present service arrangement. How are things presently done and how will your proposal improve access to care? How may things change if you are not funded?! If you are familiar with another effort similar to yours (in ND or elsewhere) please research it and provide the reviewer with evidence. This will substantiate your argument. Replication of an activity in an area that presently does not have that service or delivery mechanism is actually innovative. It also shows reliability and credibility. FLEX Grant Writing Tips! Budget Issues: " The committee generally does not fund the same idea more than once for a hospital (e.g., Chargemaster review). " Keep equipment requests to a minimum and try to address items that cost up to $5,000. This does not mean to negate bigger ticket items but provide strong supporting evidence and arguments to support the request. " Salary can be requested. It needs to be associated with the project and a documented effort form on your letterhead will need to be provided. " If working with another entity and their staff it is better to request salary as a consultant cost. " Travel expenses can be requested. " Budget narrative is very important. This explains the request. Provide the reviewer with detail. 10

11 FLEX Grant Writing Tips! More emphasis on network activities (EMS Network and Network Enhancement) " Reviewer needs to understand how the different organizations will work together, how they will make decisions, what are the areas of responsibility, and what are the roles. " Do not allude to impact on other organizations but offer specific detail on how it will impact and benefit them. " If a CAH grant involving one CAH can have impact on other providers, then the applicant needs to specify that impact and benefit. FLEX Grant Writing Tips! Ideas to consider for networking: " Quality improvement " EMS activities " Recruitment/Retention (Workforce) " FQHC/CAH " Community Access Program (Northland Healthcare Alliance) model + Local staff shared between facilities to assist in Medicaid/ SCHIP enrollment significant financial impact on hospitals + Community education and health fairs 11

12 FLEX Grant Writing Tips! Ideas to consider for networking (cont.): " Surgery networks " Staffing networks " Behavioral health " Telehealth " Protocol planning and development Network A Few Broad Observations! Rural Health networks form in reaction to a perceived change in the environment! The initial perceived threat and opportunity that draw rural providers into alliances may not be the primary problem upon which mature rural health networks concentrate their energies.! A planning process is crucial to identifying network goals, programs, and actions.! Networks obtain and use data for planning and evaluation. 12

13 Network A Few Broad Observations (Cont.)! Formal organization promotes network cohesion.! Grant funding from multiple sources provides the start-up capital for networks.! Rural Health networks take time to develop! Provider vs. community interests! Shoring up the safety-net (Source: Building Rural Health Networks, ORHP web page, Network Development Grant Program) For more information, contact: PO Box 9037 Grand Forks, ND Tel: (701) Fax: (701) bgibbens@medicine.nodak.edu 13