The Rural Hospital Flexibility Program Annual Meeting

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The Rural Hospital Flexibility Program Annual
Meeting

• Steven Hirsch
• U.S. Department of Health and Human Services
• Health Resources Services Administration
• Office of Rural Health Policy (ORHP)
• St. Paul, MN
• August 14, 2006

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Old Issues That are Still with Us

• Interpretive Guidelines
• Construction of New Facilities
• Relocation
• Medicare Advantage
• Access to Capital
• Sunset of Necessary Provider Waiver

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(No Transcript)
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CAHs Certified by Year
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The Federal Health Care Environment in 2006

• HHS Performance Measurement
• Government Performance Results Act (GPRA)
• Program Assessment Response Tool (PART)
• Medicare Compare Web-Sites (and ties to
  reimbursement)

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The Federal Health Care Environment in 2006

• Getting Parted
• A Way to Assess Federal Programs Avoid
  Duplication
• A Way to Make Funding decisions
• Measurement Focused
• Political Dimensions

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The Federal Health Care Environment in 2006

• The Rating
• Adequate (Compared to Effective or Moderately
  Effective)
• Better than Ineffective or Results Not
  Demonstrated

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A Realization

• Performance Improvement and Measurement is the
  Right Thing to Do

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Flex Performance Measures

• What Do We Measure and How Do We Measure It?
• Changes in CAHs and Eligibles
• Changes in Communities
• Work of Grantees

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Flex Performance Measures

• CAH margins
• CAHs have generally become more profitable
• Total Margin in 1998 0.15
• Total Margin in 2004 2.05

Source Flex Monitoring Team
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Flex Performance Measures

• HIT Activities in CAHs
• Baseline Survey completed in 2006
• CAHs have relatively high use rates for many
  administrative and financial HIT applications
• CAHs have relatively lower use rates for a number
  of clinical applications, such as bar-coded
  patient identification bracelets and electronic
  medical records.

Source Flex Monitoring Team Briefing Paper No. 11
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Flex Performance Measures

• HIT Activities in CAHs
• Baseline Survey completed in 2006
• Half of CAHs have a formal Information Technology
  (IT) plan, and three-quarters of CAH budgets
  include funding for purchasing IT
• The vast majority of CAHs have high speed
  Internet access, and many CAHs are computerizing
  radiology, lab, and pharmacy functions

Source Flex Monitoring Team Briefing Paper No. 11
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Flex Performance Measures

• HIT Activities in CAHs
• CAH use rates for several technologies are lower
  than the overall rates for hospitals reported by
  the American Hospital Association and others.

Source Flex Monitoring Team Briefing Paper No. 11
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Flex Performance Measures

• Hospital Compare Website, Number of CAHs
  participating
• Overall, 41 of CAHs were participating in to
  some degree (by submitting data on at least one
  measure) as of September 2005.
• By State, the percent of participating CAHs
  ranges from 0 to 86.
• Four States have no CAHs participating in
  Hospital Compare

Source Flex Monitoring Team Briefing Paper No. 9
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Grantee Performance Measures

• Mini-grants All Funding Activities That Would
  Ultimately Benefit the Hospitals.
• Average Amount in Grants (per State) in FY 2005
  152,047

Source Reports from 40 out of 45 Grantees
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Grantee Performance Measures

• Contracts to Organization or Consultants In Order
  to Aid Critical Access Hospitals or Similar Rural
  Hospitals
• Average Amount in Contracts (per State) in FY
  2005 156,071

Source Reports from 40 out of 45 Grantees
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Grantee Performance Measures

• Total Amount in Grants and Contracts
  12,632,842
• Total Amount Awarded to State in FY 2005 22.2
  Million
• Approximately 57 of Awards are distributed via
  Grants and Contracts that directly benefit CAHs
  and Eligible Hospitals

Source Reports from 40 out of 45 Grantees
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Future of Performance Measurement in the Flex
Program

• Greater detail in the Application Process
• Quantitative rather than Qualitative Measures
• Tracking Benefits to the Hospitals and Communities

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Future of Performance Measurement in the Flex
Program

• Greater detail in the Application Process
• Every year we ask how many CAHs and Eligibles
  Grantees will work with
• With many applications it is very difficult to
  find this information

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Future of Performance Measurement in the Flex
Program

• Quantitative Rather than Qualitative Measures
• How many CAHs or Eligibles receive direct
  funding?
• How much of the Grant funding can be shown to
  directly benefit CAHs or Eligibles?
• Demonstration of buy-in from Stakeholders such as
  SRHA, SHA, others

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Future of Performance Measurement in the Flex
Program

• Tracking Benefits to the Hospitals and
  Communities
• What were outcomes of Mini-Grants and Contracts?
• What Needed Services are Offered That Were Not
  Available Before?

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Future of Performance Measurement in the Flex
Program

• EMS Measures
• What Quantitative Outcomes can be Demonstrated?

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Contact

• Steven Hirsch
• 301-443-7322
• shirsch_at_hrsa.gov
• Main line 301-443-0835
• Fax [phone]
• http//ruralhealth.hrsa.gov