Hospital State Division

1. Hospital State Division Kristi Martinsen Hospital State Division Director HSD Overview September 2013 Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy

2. HospitalState Division - Regional Liaisons Jeanene Meyers Natassja Manzanero Dan Mareck Keith Midberry David Dietz Megan Meacham E A C B Bridget Ware Sarah Young D Steve Hirsch

3. Hospital State Division Collaborative Partnership

4. Office of Rural Health Policy (ORHP) Activities Improving Rural Health Initiative “Within the total amount requested for Rural Health Activities, the Budget includes $79 million to continue the President’s initiative to improve rural health. The goal of this initiative is to improve the access to and quality of health care in rural areas.”

5. Office of Rural Health Policy (ORHP) Activities Improving Rural Health Initiative: Key Elements

6. Hospital State Division (HSD) Overview Focus Programs • Measuring and Improving Outcomes • Using and Sharing the Program Data • Collaborating and Sharing Best Practices • Aligning Programs to the Health Care Environment • Program Integrity • Grants • State Offices of Rural Health (SORH) • Medicare Rural Hospital Flexibility Program (FLEX) • Small Hospital Improvement Program (SHIP) • Initiatives • Flex Medicare Beneficiary Quality Improvement Project (MBQIP) • Delta Rural Hospital Performance Improvement Project (RHPI)

7. Hospital State Division (HSD) Grants: State Offices of Rural Health (SORH) Purpose Awards • State / Federal partnership • assist States in strengthening rural health care delivery systems • Establish & maintain clearinghouse • Coordinate activities within state to avoid duplication of effort & activities. • Provide technical assistance • Encourage recruitment & retention of health professionals • FY 13 grant guidance competitive • New 3 year project period • Submit via Grants.gov • Focus on key SORH activities for all 50 states

8. Hospital State Division (HSD) SORH Grant TA Partners • National Organization of State Offices of Rural Health • Provide education, resources and TA to State SORH Programs • http://www.nosorh.org

9. Hospital State Division (HSD) Grants: Outcomes Focus – Quality and Performance Improvement Grantee (State) Process Program (National) Context

10. Hospital State Division (HSD) Grants: Small Rural Hospital Improvement Program (SHIP) Purpose Awards • Encouraging Networking • Strategically Using Grant Dollars • Updated SHIP Categories Aligned to Affordable Care Act • ICD 10 Updates: http://www.cms.gov/ICD10/ • Competitive in FY 13: Awards coming out any day for 9/1 start date • **In 2016 will change to a 6/1 start date • Anticipated amount of award: ~ $8800 per hospital • FY13 SHIP Focus: • MBQIP Activities (Inpatient and HCAHPS) • ICD-10 • Innovations group for health IT projects and community-based interventions

11. Hospital State Division (HSD) SHIP Grant TA Partners • Technical Assistance and Services Center • Provide education, resources and TA to State SHIP Programs • http://www.ruralcenter.org/tasc

12. Hospital State Division (HSD) • Grants: Medicare Rural Hospital Flexibility Program (FLEX) • Four Core Focus Areas:

13. Flex In Motion

14. Hospital State Division (HSD) Flex Grant TA Partners • Technical Assistance and Services Center • Provide education, resources and TA to State Flex Programs and CAHs • http://www.ruralcenter.org/tasc • Flex Monitoring Team • CAH Financial Indicator Reports • State Hospital Compare & Quality Measure Reports • Other briefs & reports yearly on quality, finance, and community engagement • www.flexmonitoring.org

15. Medicare Beneficiary Quality Improvement Project (MBQIP) • Pilot project focusing upon quality improvement and data reporting • Common clinical and process metrics (i.e., syncing with NQF and Hospital Compare) • Measuring outcomes and demonstrating improvements via evidence-based practices • Sharing evidence-based practices http://www.hrsa.gov/ruralhealth/about/video/index.html

16. Hospital State Division (HSD) Medicare Beneficiary Quality Improvement Project (MBQIP) • Reporting on Rural-Relevant and Common National Measures • Measuring Outcomes and Demonstrating Improvements • Sharing Best Practices Goal: 100%

17. Hospital State Division (HSD) Medicare Beneficiary Quality Improvement Project (MBQIP) http://www.hrsa.gov/ruralhealth/about/video/index.html

18. Health Reform Initiatives Partnership for Patients • Reduce harm caused to patients in hospitals. We will accelerate the reduction of preventable harms to inpatients starting now, so that by the end of 2013 we will observe a 40% reduction in preventable harm compared to 2010. Based on our calculations, this would mean almost two million fewer injuries to patients and more than 60,000 lives saved. • Reduce preventable hospital readmissions. We will advance efforts to decrease preventable hospital readmissions within 30 days of discharge, so that by 2013 all readmissions would be reduced by 20% compared to 2010. This would mean prevention of more than 1,600,000 hospital readmissions. Achieving these two goals will not only save lives and greatly reduce injuries to millions of Americans, it will also result in savings of billions of dollars that help put the nation on the path to having a more sustainable health care system.

19. White House Rural Council

20. Office of Rural Health Policy (ORHP) Activities White House Rural Council • Access to Capital Workgroup • August 2012 • Brought together federal partners and rural stakeholders to discuss challenges and opportunities • Upcoming resource guide for SORHs and rural hospitals on capital resources

21. Resources Workforce: Linking Rural Health Care Providers to the Federal Workforce Programs • HRSA Programs such as... • National Health Service Corps • Nursing Loan Repayment • Primary Care Training • Nursing Education • Key Challenge: Linking Providers & Educational Institutions • http://www.hrsa.gov/ruralhealth/pdf/ruralhealthfundingguidance.pdf

22. ORHP Affordable Care Act Activities • Weekly Office Hour Calls • Wednesdays, 3-4 pm Eastern Time • Call-in Number: (800) 857-3749; Passcode: ORHPACA • Adobe Connect Session: https://hrsa.connectsolutions.com/orh1/ • 6/13 Topic: ACA 101 • 6/27 Topic: ACA Medicaid Expansion101 • 7/10 Topic: Consumer Assistance • 7/17 Topic: SHOPs, Tax Credits/Subsidies, and the Unbanked Population • 7/24 Topic: Minimum Coverage Provision, Exemptions, Subsidies and Dual Eligibles • 7/31 Topic: Consumer Assistance • Questions and Distribution List • orhp-acaquestions@hrsa.gov: Email this address with any questions and if you want to be added to the ORHP distribution list for emails on resources and call information

23. What rural providers need to know about the Health Insurance Marketplaces: • What kind of Marketplace does your state have? How many uninsured individuals are in your area? STEP 1: • Ask Insurance Commissioners/Marketplace which Qualified Health Plans (QHP) are participating. STEP 2: • Educate QHPs about your role in rural communities. • Inform QHPs if you are an Essential Community Provider. • Begin negotiating contractswith QHPs. STEP 3: • Refer patients to Consumer Assistance Programs in your state. Talk to your patients about their eligibility and enrollment options. • Refer patients to Healthcare.gov. STEP 4:

24. Contact Information Kristi Martinsen Hospital State Division Director 301-594-4438 kmartinsen@hrsa.gov www.hrsa.gov/ruralhealth