Transcript FY 2015-2016 Workplan - Michigan Center for Rural Health

Michigan Medicare Rural
Hospital Flexibility
Program
FY 2016-2017
Crystal Barter
2016 CAH Conference
Medicare Rural Hospital
Flexibility Grant Program
O Established through the Balanced Budget Act of
1997
O Aims to improve access to preventive and emergency
health care services for rural populations.
O Allows small hospitals to be certified as Critical
Access Hospitals (CAHs) and offers grants to States
to help implement initiatives to strengthen the rural
health care infrastructure.
O Administered by the Health Resources Service
Administration’s Federal Office of Rural Health
Policy. HRSA is a division of the U.S. Department of
Health and Human Services.
Flex Program Core Areas
O Quality Improvement
O Financial and Operational Improvement
O Population Health Management
O Emergency Medical Services
O Formally Health Systems Development and
Community Engagement
FY 15-16 Accomplishments
Quality Improvement
O 2015 MI CAH Conference
O Support 4 Quarterly MICAH QN Meetings
O Provided Data Analysis and Benchmarking
Support to MI CAHs
O Support Medicare Beneficiary Quality
Improvement Project Participation
MICAH QN Executive
Committee
O President – Barb Cote, Spectrum Health Reed City/Big Rapids
O Vice President – Chris Wilhelm, Munson Healthcare Charlevoix
O Secretary – Christine Trisch, Caro Community Hospital
O Treasurer – Mariah Hesse, Sparrow Clinton
O SG #1 Chair – Barb Wainright, Spectrum Health Gerber
O SG #2 Chair – Jen Anderson, Sparrow Ionia
O SG #3 Chair – Anne Holmes, Paul Oliver Memorial Hospital
O Christi Salo, Munising Memorial Hospital
O Deb Han, Aspirus Iron River
O Wanda Bartholomew, Hayes Green Beach Memorial Hospital
O Christine Bissonette, Kalkaska Memorial Hospital
MICAH QN Support
O All 36 MI CAHs participate (+ 3 rural PPS)
O Peer Education
O Benchmarking
O MICAH QN Core Measures
O Reported to Hospital Compare/CMS
O Medicare Beneficiary Quality Improvement
Metrics (MBQIP)
O Partner Updates
O MHA Keystone
O BCBS Pay-for-Performance
O MPRO
Focus Areas – Alignment with
the National Quality Strategy
O Making care safer by reducing harm caused
in the delivery of care
O Promoting effective communication and
coordination of care
O Working with communities to promote wide
use of best practices to enable healthy
living.
Making Care Safer by Reducing Harm
Caused in the Delivery of Care
O Focusing on Patient Safety/Culture
O Provided education on Patient Safety Organization (PSO)
O
O
O
O
O
reports from MHA
MICAH QN Member on MHA PSO Advisory Committee
High Reliability Presentations (2) by Gary Roth, MD – MHA
Keystone
Rounding with a Purpose Peer Presentations and
Resources Shared (February 2016)
Safety Story time was made a standing agenda item
Interactive session at May 2016 MICAH QN meeting to
determine high needs
O ED, Diagnostics, Surgery Handoff
O TeamStepps Communication Tools Training – November
2016
Promoting Effective Communication and
Coordination of Care
O
Focus on the Medicare Beneficiary Quality Improvement Project (MBQIP)
Emergency Department Transfer Communication Bundle
O
O
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O
O
O
O
O
Administrative Communication
Patient Information
Vital Signs
Medication Information
Physician or Practitioner Generated Information
Nurse Generated Information
Procedures and Test
Progress Thus Far:
O
O
O
O
O
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Robust conversation on the challenges surrounding obtaining 100% compliance.
Standardized the number of charts that CAHs pull (still have one/two that pull more
than 45)
Peer Sharing on Best Practice regarding EDTC 5-6 (Feb 2016)
Education on the importance of public recognition of staff (Feb 2016) (May 2016)
Promotion of “two-staff check” as a best practice (Feb 2016)
Direct education to two CAHs with most opportunity for improvement
Best Practice education surrounding obtaining 100% compliance with Medications,
History and Physical and Sensory Status.
EDTC Improvement
120
98
97
100
84
84
97
83
98
94
81
80
90
77
89
85
76
76
60
55
Q12015
Q32016
40
20
0
EDTC-1
EDTC-2
EDTC-3
EDTC-4
EDTC-5
EDTC-6
EDTC-7
EDTC-All
Working with Communities to Promote
Wide Use of Best Practices to Enable
Healthy Living
O Goal: Each MI CAH will implement a project working with the
school district or local industry to improve the health of their
community addressing a specific social/economic determinant
of health.
O Progress Thus Far:
O
O
O
O
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Healthier Communities Toolbox Developed
County Health Rankings Presentation to MICAH QN members and
to CAH CEOs and CFOs (November 2015)
AL!VE presentation (May 2016)
Lenawee Health Network Presentation (May 2016)
Survey to MICAH QN members distributed (August 2016) to
determine projects and what additional resources needed.
Medication Disposal (Community Level) and Community Flu
Prevention Presentations (November 2016)
AL!VE and Cranium (November 2016)
Peer
Education
OP4c - Aspirin at Arrival - Chest Pain
100.0%
99.0%
Rate
98.0%
97.0%
96.0%
95.0%
94.0%
MICAHQN
Overall
UCL
LCL
14
OP AMI/CP Continuous Measures - 1Q16
5
Median Time to ECG - Chest Pain
7
6
2
Median Time to ECG - AMI
6.5
6
4
Median Time to ECG - Overall Rate
7
6
71
Median Time to Transfer to Another Facility for Acute Coronary
Intervention - QI Measure
66
66
33.5
Median Time to Transfer to Another Facility for Acute Coronary
Intervention - Reporting Measure
48
43.5
33.5
Median Time to Transfer to Another Facility for Acute Coronary
Intervention - Overall
59.5
52.5
8
Median Time to Fibrinolysis
29
28
0
10
20
30
40
50
60
70
80
Median Time
Rural Only Values
CAH Only Values
MICAHQN Values
15
FY 2015 – 2016 MBQIP
O Voluntary Quality improvement activity under
the Flex Program, established by the Office
of Rural Health Policy.
O Increasing the voluntary quality data
reporting by CAHs, and then driving quality
improvement activities based on the data.
FY 2015 – 2016 MBQIP
Accolades for Quality
MICAH QN National Presence
O Federal Office of Rural Health Policy Visit
(August 2015)
O National Rural Quality Advisory Council
O NQF Emergency Department Quality of
Transitions of Care Project Expert Panel
O Consistently recognized as high performers,
and leaders in the CAH world.
FY 15-16 Financial and Operational
Improvement
O
CAH Financial Benchmarking
O
MI CAH Analysis
O
O
O
O
Revenue Analysis
Balance Sheet Analysis
Historical Trends (10 years)
Board of Directors Education
O
O
O
O
O
O
O
O
O
Health Care Reform and Accountable Care Organizations
Developing Strategic Relationships with Regional and National Partners/Developing
Effective Systems of Care with Local Primary Care and Post-Acute Care Providers
Challenges and Threats to the Critical Access Hospital Program and Cost-Based
Reimbursement
Governance Development and Board Best Practices
Medical Staff and Credentialing Issues
Succession Planning and Development/Managing a Leadership Transition
Developments in Quality Measures, Quality Data and Quality Reporting
Requirements
Structuring Relationships with Independent and Employed Physicians
Reimbursement and Healthcare Finance Module
FY 15-16 Financial and
Operational Improvement
O Lean Analysis in the Outpatient Setting
O Lean Analysis in the Inpatient Setting
O Service Line Assessments
Oupatient (5) and Inpatient
Lean Assessment and Analysis
(2)
–
Rybar
O Entire patient cycle
O Staffing ratios
O External benchmarks
O Interviews with staff
O Analysis of department expenses.
O Specific deliverables include two 2-day
onsite analyses, two in-depth final reports
detailing findings, and two half-day site visits
to review the implementation processes
Lean Assessment
Allegan Professional Health Services
Helen Newberry Joy
McKenzie Health System
Deckerville Community Hospital
Sheridan Community Hospital
General Themes/Takeaways from projects
O
Development of standard work for check-in and rooming process, implemented auto
patient appointment reminders, and eliminated the patient check-out process
O
Director will develop changes to provider contracts to better incentive and to increase
capacity and provider productivity
O
Will deploy a patient kiosk to enable patient self-registration.
O
Working on developing standard work and formalizing/clarifying roles for MAs and
front-desk person(s)
O
Director/manager considering staffing front desk with MAs rather than
phone/receptionist
O
Hired a leader (manager) to manage daily clinic operations and “own” accountability
(severe leadership and teamwork issues in clinic – impacting patient satisfaction
O
Stopped ‘quasi phone triage” process – developed improved standard work; clarified
and reinforced roles; developed communication expectations for front-desk staff and
MAs
Service Line Analysis
Caro Community Hospital
Sheridan Community Hospital
Sparrow Ionia Hospital
OR Project
O Decreased “no-go”/re-scheduled cases due to equipment organization/acquisition
O Created Pre-op RN role and changed protocol/expectations for communicating with
patient through the referral and scheduling process
O New process for referral and scheduling process
Leadership Survey, Leadership Development, Hospital Re-Branding Project, New Mission,
Vision, Values
Surgery Referral Process Improvement
O Hired RN Surgery Coordinator, Changed communication protocol for reaching out to
patients earlier in the referral process in order to more proactively manage and set
expectations
O Developed standard work for major parts of surgery scheduling process
New Employee
Jeffery S. Nagy
Quality Improvement Advisor
Michigan Center for Rural Health
909 Fee Road
B-218 West Fee Hall
Michigan State University
East Lansing, MI 48824
Direct Line: 517-884-8641
Fax: 517-432-0007
Email: [email protected]
www.mcrh.msu.edu
Population Health Management
and EMS Integration
O Four EMS Leadership Academies (Levels 1 –
4).
O 99 Personnel
O CALS – 12 personnel from 3 CAHs (not Flex
funded)
O EMS Webinars – Bi-monthly (6)
Population Health Management
O Statewide CAH Population Health
Management Needs Assessment
O Conduct Regional Population Health
Management Needs Assessment Analysis
O Top 5 needs
O Four community meetings in four Trauma
Regions
O Action plans developed
O Each region implements a plan to improve
population health
EMS Integration
O To understand the community health and
EMS needs of the CAH Community.
O Develop a survey to supplement the “2014
MI Rural EMS Network Assessment of EMS
Services”.
O Conduct two EMS Leadership Academies
O Baseline data collected, 6-month assessment,
assessment in 6 month intervals for three
years (after last EMS Leadership Academy).
EMS Assessment - Rural
Ambulance Service Attributes
O
O
18 Categories
O Written Call Schedule, Continuing Education, Quality (QA/QI) Process, Recruitment and
Retention Plan, Formal Personnel Standards, Sustainable Budget, EMS Operations
Leader With A Succession Plan, A professional Billing Process, Contemporary
Equipment and Technology, Agency Attire, Involvement in the Community, The Agency
Reports Data , Incident Response and Mental Wellness
Medical Director Involvement
O There is a medical director in name only. He/she is not actively engaged with agency
beyond signatures.
O The medical director reviews cases presented to him/her, but not within 30 days and/or
with very little feedback.
O The medical director reviews cases presented to him/her, within 30 days and/or with
some feedback.
O The medical director reviews cases within 7 days, provides good feedback, but waits for
the (EMS) agency to engage her/him. When asked, he/she responds to hospital ED/ER
contacts on behalf of the agency regarding their clinical protocols and actions.
O The medical director is an integral part of EMS services, pro-actively engaging the
agency to review cases within 7 days and provide regular feedback, is involved in
planning and delivery of education to the agency, and advocates for the agency to
hospital ED/ER contacts.
Questions?
Crystal Barter
Director of Performance Improvement
Michigan Center for Rural Health
909 Fee Road
B-218 West Fee Hall
Michigan State University
East Lansing, MI 48824
Direct Line: 517-432-0006
Facismilie: 517-432-0007
Email: [email protected]
www.mcrh.msu.edu