The Flex Program

1
The Flex Program
This is a draft and will require insertion of
your own data

• Medicare Rural Hospital Flexibility Program

2
Goal

• Support rural communities in preserving access to
  primary and emergency health care services.

3
Participation

• 45 States receive annual federal grant funding to
  administer the program
• CT, DE, MD, NJ, RI not eligible
• Each state has developed a state rural health
  plan approved by CMS
• States maintain ongoing planning and program
  development activities

4
Administration

• State Offices of Rural Health
• Nonprofit Organizations
• Universities

5
Key Components

• Critical Access Hospitals
• Emergency Medical Services
• Quality Improvement
• Network Development Enhancement
• Rural Health Planning Evaluation

6
Critical Access Hospitals

• CAH Designation Criteria
• Located in a Rural Area
• Provide 24-hour Emergency Care
• 96-hour Average Length of Stay
• 25 Bed Maximum (including swing and observation
  beds)

7
Critical Access Hospitals

• Currently 1060 CAHs (January, 2005)
• Over XX pending in state name
• Another wave of conversions occurring as
  legislation implementation dates arrive
• Necessary Provider sunsets 1/1/2006

8
Critical Access Hospitals

• Benefits
• Medicare cost-based reimbursement - currently at
  101 percent of reasonable costs
• Exempt from inpatient and outpatient prospective
  payment systems
• Capital improvement and equipment costs may be
  included in the Medicare cost report
• May establish psych and rehab distinct part units
  up to 10 beds each
• DPU beds are paid under prospective payment system

9
Critical Access Hospitals

• Issues
• Community development
• EMS integration
• Workforce
• Evaluation
• Access to capital

10
Critical Access Hospitals

• Trends
• Shift to outpatient and long-term care
• Enhanced access to capital
• Integration of EMS
• Improved profitability
• Note CAH-owned ambulance services must meet the
  35-mile rule (35 miles from another service to be
  eligible for cost-based reimbursement)

11
Critical Access Hospitals
Data as of 11/9/2004
12
Emergency Medical Services

• Training initiatives
• -Clinical training -Billing
• -Management -Data entry
• -Equipment
• Needs assessments
• Encouraging local collaboration
• Enhancing data collection and reporting
• Workforce projects

13
Quality Improvement

• Improve QI through technical assistance and
  financial support
• Development of networks and affiliations
• Connecting hospitals and providers with resources
  for QI
• CAHs required to have agreement with network
  hospital, QIO or other qualified entity for QA
  and credentialing

14
Quality Improvement

• CAH and EMS initiatives
• Training education
• Medical error reporting
• Data feedback
• Staffing
• Use of protocols
• Error prevention systems
• Link with state hospital association, Medicare
  Quality Improvement Organization, Network hospital

15
Networks

• Patient referral and transfer agreements
• Use of communications systems for sharing patient
  data and telemetry
• QI and QA activities
• Specialty services
• Transportation
• Credentialing

16
Planning and Evaluation

• Rural Plan Requirements
• Improve access to hospital and other health
  services for rural residents
• Promote regionalization of rural health services
• Create one or more rural health networks with
  CAHs and acute care hospitals
• Program Evaluation at State Level

17
Evaluation

• Flex Program Monitoring Team
• University of Minnesota
• University of North Carolina
• University of Southern Maine
• TASC - assists with dissemination
• www.flexmonitoring.org

18
Flex Monitoring Team

• Findings
• CAH conversion associated with improved financial
  condition
• Long-term effects not yet known
• Economic impact on community is important
• Data sharing and collection will become
  increasingly important

19
Flex Monitoring Team

• Findings, continued
• Formidable barriers remain
• Life safety costs
• Medicaid
• Fiscal Intermediaries and IHS
• Reimbursement policies not well-aligned with
  long-term care
• Quality is getting more attention than expected

20
Name of State

• Flex program office
• Contact
• Web site

21
State Flex Program

• State Flex plan
• Goals

22
State Flex Program

• CAHs
• Current number, number pending
• Network
• Quality Improvement

23
State Flex Program

• CAH Success Storyies
• (year of conversion, condition prior to
  conversion, changes/activities with CAH status
  such as financial condition, service line
  changes/additions, impact on community such as
  jobs retained/added)

24
State Flex Program

• Networks

25
State Flex Program

• Quality Improvement

26
State Flex Program

• Emergency Medical Systems

27
State Flex Program

• Summary/Lessons Learned/Next Steps