Iowa Critical Access Hospital Financial Indicators Performance Improvement Kickoff Webinar 1
Agenda Project Summary Transition Framework Presentation Overview: Financial & Operational Improvement Overview: Quality Improvement Network Next Steps FINDINGS 2
About this Project This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under a grant contract with the State of Iowa. Grant No.: H54H00011 Title of Program: RURAL HOSPITAL FLEXIBILITY PROGRAM 3
Flex Program Overview The Medicare Rural Hospital Flexibility (Flex) Program was authorized by section 4201 of the Balanced Budget Act of 1997 (BBA), Public Law 105-33. The Flex program provides funding to States for the designation of critical access hospitals (CAHs) in rural communities. Critical Access Hospital designation allows the hospital to be reimbursed on a reasonable cost basis for inpatient and outpatient services (including lab and qualifying ambulance services) provided to Medicare patients. The core areas of the Programs include support for: Quality Improvement Operational and Financial Improvement Health System Development and Community Engagement Additional activities within the Flex Program include facilitating the conversion of hospitals to CAH status; supporting network development; and, supporting for workforce issues. FINDINGS 4
About Stroudwater Stroudwater designs solutions for healthcare leaders most pressing challenges. Founded in 1985, we are a national advisory firm serving exclusively healthcare clients, and we are proud to have friends and clients in all 50 states. We employ thought leadership and focused analytics in a collaborative process that engages our clients and empowers their transformation. Our practice areas are highly focused on the mission-critical strategic, operational, and financial areas where our perspective offers the highest value. Our solutions are client-driven and client-focused. Instead of selling a product or offering a prepackaged solution, we are your trusted advisors on the journey of discovering the unique solution for each client need. FINDINGS 5
Project Summary Funded by the Iowa Office of Rural Health through the Rural Hospital Flexibility (Flex) Program Available to all Iowa Critical Access Hospitals (CAHs) Flex grant Fiscal Year September 1, 2017 August 31, 2018 Quality Improvement Financial and Operational Improvement Collaborative initiative among all 82 Iowa CAHs to simplify data collection, benchmark data, identify variation and achieve performance improvement CAH-specific consulting engagements for a subset of eligible facilities (11 CAHs are able to participate this Flex Fiscal Year) FINDINGS 6
Financial Indicators Transition Framework 7
Transition Framework FINDINGS 8
Financial Indicators Finance and Operations 9
Project Overview The Iowa Department of Public Health (IDPH) has created a program specifically intended to help improve the financial and operational performance of Iowa s CAHs This is a no-cost opportunity, fully funded by the 2018 Medicare Rural Hospital Flexibility (FLEX) Program The FLEX program aims to improve access to preventative and emergency healthcare services for rural populations Participating CAHs will receive a Strategic Financial and Operational Assessment (SFOA) The objective of the SFOA is to conduct rapid and focused analyses of targeted areas within your hospital that result in the identification of both concrete opportunities for operational and financial performance gains and a concise starting point for strategic planning 10
Engagement Methodology Phase 1 Data Request Phase 2 Data Analysis Phase 3 Site Visit Phase 4a Draft Report Phase 4b Final Report Stroudwater analysts develop market, service area and historical performance findings to be incorporated into the Final Report using public, proprietary and hospital-provided data. Data sources include: Detailed IP and OP utilization data Recently-filed Medicare Cost Reports Latest PS&R reports Audited financial statements Financial and utilization projections Stroudwater conducts a set of onsite key informant interviews with CEO, CFO, CNO, senior leadership team members, medical staff, selected department managers and board members. Prior to site visit departure, preliminary findings and recommendations are reviewed with senior hospital leadership Stroudwater prepares and submits to hospital administration a Draft Financial & Operational Assessment Report based on findings from the Data Analysis and interviews conducted during the Site Visit. Pending feedback, Stroudwater submits a Final Report. Phase 5 Action Planning Optional component of the Financial & Operational Assessment process designed to facilitate the development of concrete action plans based on prioritized recommendations 11
SFOAs to Date and Eligibility 2 7 55 Financial Indicators Iowa CAHs have received an SFOA Iowa CAHs are Still Eligible for SFOA 12
Important Dates and Milestones November/December 2017 Select CAHs to participate Kick-off conference call with leadership team Data request completion December 2017 - January 2018 Site visit with leadership team Strategic, financial and operational assessment Assessment review with leadership team February July 2018 Ongoing follow-up and technical assistance August 2018 Report measurable outcomes and implemented recommendations 13
What s Next: Finance 2 7 55 Apply Now! Amanda Ramirez amanda.ramirez@idph.iowa.gov 14
Our Finance Team Lindsay Corcoran lcorcoran@stroudwater.com Office: (207) 221-8262 Jonathan Pantenburg jpantenburg@stroudwater.com Office: (207) 221-8253 Eric Shell eshell@stroudwater.com Office: (207) 221-8252 15
Financial Indicators Quality Improvement Network 16
QI Project Timeframe Kickoff Webinars Network Face to Face Meeting (A) Network Face to Face Meeting (B) September 2017 August 2018 EDTC Webinar Webinar A Webinar B Webinar C Needs Assessment Data Onboarding 17
Quality Improvement Overview Quality Improvement Components MBQIP Four Domains Patient Safety Patient Engagement (HCAHPS) Care Transitions (EDTC) Outpatient 18
MBQIP Measures ID Measure Name Data Reported To OP 1 Median Time to Fibrinolysis QNet via OP CART/Vendor OP 2 Fibrinolytic Therapy Received Within 30 minutes of QNet via OP CART/Vendor ED Arrival OP 3 Median Time to Transfer to Another Facility for QNet via OP CART/Vendor Acute Coronary Intervention OP 4 Aspirin at Arrival QNet via OP CART/Vendor OP 5 Median Time to ECG QNet via OP CART/Vendor OP 18 Median Time from ED Arrival to ED Departure for QNet via OP CART/Vendor Discharged ED Patients OP 20 Door to diagnostic evaluation by a qualified QNet via OP CART/Vendor medical professional OP 21 Median time to pain management for long bone QNet via OP CART/Vendor fracture OP 22 Patient left without being seen QNet via Online Tool OP 27 Influenza vaccination coverage among healthcare personnel National Healthcare Safety Network Website IMM 2 IP Influenza immunization QNet via CART/Vendor HCAHPS IP Satisfaction QNet via Survey Vendor EDTC Emergency Department Transfer Communication Stroudwater or Other 19
FY 2018 21 Measures 20
Patient Safety 21
Patient Engagement 22
Care Transitions - EDTC 23
Outpatient 24
XXXX Memorial Hospital State Hospital Action Item Outcome Memorial Hospital Initiate Barthel Index with new physical therapy staff New physical therapy staff started. PT/OT staff has started to use Barthel Index on newly admitted swing bed patients. C.N.A. staff has started to receive education on use of Barthel to assist with data collection. 25
Our Quality Team Carla Wilber cwilber@stroudwater.com Office: (207) 221-8276 Contact me if you have questions about the network or want to request TA Paula Knowlton pknowlton@stroudwater.com Office: (207) 221-8259 Gregg Lathrop glathrop@stroudwater.com Office: (207) 221-8266 26
Financial Indicators Next Steps 27
Next Steps Finance 2 7 5 5 Quality 82 Apply Now! Work on Action Plans November 2017 1. Steering Committee (Y/N) 2. Survey Monkey 3. EDTC Webinar 4. Meeting Dates Set December 2017 1. MBQIP TA Webinar #1 All Webinar Attendees will Receive a Follow-up Email 28
QI Steering Committee We re Looking for 4-5 CAH Champions Contact us by Friday, November 10th Review and inform project plan Suggest geographic breakouts (locations, sequence and timing) Vet and endorse Needs Assessment survey Facilitate collaboration with other state-based Quality programs Contact me if you want to be a member of the Iowa QI Steering Committee Paula Knowlton pknowlton@stroudwater.com Office: (207) 221-8259 29
Financial Indicators Comments & Questions 30