1. Montana Rural Hospital Flexibility and Rural Healthcare Performance Improvement Network Orientation Program December 2011

2. Some common acronyms… Flex = Rural Hospital Flexibility Program PIN = Performance Improvement Network DPHHS = MT Dept of Public Health and Human Services MHREF = MT Health Research and Education Foundation, the not-for-profit arm of MHA MHA = MT Hospital Association

3. Some common acronyms… CAH = Critical Access Hospital QI = Quality Improvement PI = Performance Improvement CMS = Centers for Medicare and Medicaid Services

4. Montana’s Flex Program  MT Grantee = DPHHS Quality Assurance Division Jeff Buska, Administrator Kathy Lubke, Program Officer  DPHHS contracts with MHREF to administer Flex funded activities  DPHHS retains program evaluation, fiscal management responsibilities and some activities Flex grant year runs from September 1 thru August 31

5. Flex/PIN Staff Flex Director Carol Bischoff457-8016carol@mtha.orgcarol@mtha.org Rural Hospital Quality Coordinator Kathy Wilcox461-6186kathy@mtha.orgkathy@mtha.org

6.  St. John’s Lutheran Hospital  Clark Fork Valley Hospital  Mineral Community Hospital  Marias Medical Center  Liberty Medical Center  Pondera Medical Center  Teton Medical Center  Missouri River Med. Center  Big Sandy Med. Center  Powell Co. Medical Center Granite Co. Medical Center   Ruby Valley Hospital  Barrett Memorial Hospital  Mountainview Medical Center  Livingston Healthcare  Pioneer Medical Center  Stillwater Comm. Hospital  Beartooth Hosp. & Health Center  Rosebud Health Care Center  Dahl Memorial Healthcare Assoc.  Fallon Medical Complex  Prairie Community Hospital  Garfield Co. Health Center  McCone Co. Health Center  Roosevelt Med. Center  Poplar Comm. Hospital  Sheridan Memorial Hosp.  Frances Mahon Deac. Hospital  Phillips County Hospital  Wheatland Memorial Healthcare Montana Critical Access Hospital Program Status December 2011  Critical Access Hospitals Potential Critical Access Hospital  Broadwater Health Center  Madison Valley Hospital  St. Luke Comm. Hospital  Glendive Medical Ctr  Big Horn County Memorial Hospital  St. Joseph Hospital  Community Hospital of Anaconda Marcus Daly Memorial Hospital   North Valley Hospital  Northern Rockies Medical Center  Daniels Memorial Healthcare Center NE MT Health Services  Fort Belknap Service Unit  Crow/N. Cheyenne Indian Hospital  Roundup Memorial Healthcare  Sidney Health Center Blackfeet Comm. Hospital  Central Montana Medical Center  Holy Rosary Healthcare

7. Flex Grant Activity Sampler Core activities QA/QI/PI: support for meeting Conditions of Participation and performance improvement projects: benchmarking, clinical improvement & benchmarking, quality education & support network, PIN ListServ Meetings: CEOs twice each year; DON Forum; QI Showcase; Champions for Quality regional meetings; Regional joint QIC/DON Coding workshops Other projects vary from year to year CAH CFO networking options HIT web-based resource book Balanced scorecard development Facility specific economic impact reports Cost report review Leadership Institute Lean internships PIN website THE LIST IS ALMOST ENDLESS!

8. Flex Grant Core Area #1 Quality Improvement

9. Medicare Beneficiary Quality Improvement Project Precursor to value-based purchasing for CAHs? Phase 1 Measures (HRSA collects data, Sept 2011 forward) Pneumonia: Hospital Compare CMS Core Measures Congestive Heart Failure: Hospital Compare CMS Core Measures Phase 2 Measures (HRSA begins data collection Sept 2012) Outpatient 1-7 as specified in Hospital Compare (AMI-ED, SCIP) Hospital Consumer Assessment of Healthcare Providers and Systems Phase 3 Measures (HRSA plans to begin data collection Sept 2013) Pharmacist Review of Medication Orders within 24 hrs Outpatient Interfacility Communication Goal #1-Support efforts to improve and sustain quality of care

10. More later… Goal #1-Support efforts to improve and sustain quality of care

11. Flex Grant Core Area #2 Operational and Financial Improvement

12. Meetings Coding workshops CFO Networking Leadership Institute Lean internships HIT Training Goal #2- Support efforts to improve Montana CAH financial and operational performance

13. CAH Administrators Winter Mtg LivingstonFebruary 8-10, 2012 DON Forum Helena March 21-23, 2012 CAH Administrators Fall Mtg BillingsSept 19, 2012 Goal #2- Support efforts to improve Montana CAH financial and operational performance

14. Coding workshops: 7 th year! Integumentary system-May 23-June 20 ICD 10 and PCS training-July 12 and 26 CFO Networking: ListServe; HFMA scholarships Spring 2012 Leadership Institute Billings and Helena-Apps available Jan 2012 Goal #2- Support efforts to improve Montana CAH financial and operational performance

15. Lean Process Management Apps available February 2012 HIT Education Programs -HIT Certification Program- MT Tech, Butte Apps available April 2012 -IT/HIT Literacy- Helena College Of Technology -HIMSS scholarships Goal #2- Support efforts to improve Montana CAH financial and operational performance

16. Flex Grant Core Area #3 Health System Development and Community Engagement

17. CHSD-Community Health Services Development Year 6-Needs assessment and community health care planning Applications available by 12/31/2011 Explore development of local systems of care Goal #3- Support efforts to assist CAHs in developing systems of addressing community needs

18. Significant Flex resources support the Montana Rural Healthcare Performance Improvement Network (PIN)

19. Performance Improvement Network Formed at request of CAH CEOs in 2001 All 48 MT CAHs are members Governance provided by PIN Advisory Board o up to 10 members: CEOs, DONs, QI/PI, CFO Clinical oversight provided by the Clinical Improvement Panel (CIP)

20. Performance Improvement (PI) Program C-0191Agreements with qualified entities C-0195Agreements for Credentialing and Quality Assurance C-0271Clinical policies and procedures

21. Performance Improvement (PI) Program C-0330“Periodic Evaluation”, ie, the Annual CAH Program Evaluation C-0336“An effective QA program”: the expectation of measurable improvement C-0337All patient care and other services affecting patient health and safety are evaluated

22. Performance Improvement (PI) Program C-0338Includes nosocomial infections and medication therapy C-0339Includes quality and appropriateness of diagnosis and treatment (ie, “peer review”) C-0341Considers findings and recommendations from the QIO and takes corrective action C-0342Takes appropriate remedial action to address deficiencies found through the QA program (ie, CAH survey deficiencies)

23. Performance Improvement (PI) Program Provides support for in-house PI staff o Opportunities for improving performance  Clinical improvement studies, clinical benchmarking  Scholarships for attending MTAMSS, June, Bozeman  New!! PIN Peer Review program- enroll Feb 2012 o Education, training and PI resources  PIN Education Committee: CAH sample policies o Regulatory information and support (CMS)  Admin Rules of MT webinar; Jan 19, 2:00 pm

24. Performance Improvement (PI) Program Support for in-house staff, cont. o Peer Networking  QI Showcase April 17-19  Joint QI Coord and DON regional meetings,Oct 2012 o Consultation  onsite as requested o Engaging administration and medical staff  Administrator meetings; clinical improvement panel and studies; Champions and Lunchtime Learning

25. Engaging Medical Staff Champions for Quality 2012 Medical Education, CMEs, Nursing CE credits 100% say this conference is worth their time to attend! New approach under development for 2012

26. Facility Staff Support Resources “Best Practice” tools, resources and education PIN ListServ pin@astro.lyris.netpin@astro.lyris.net Quarterly PIN newsletter PIN website www.mtpin.orgwww.mtpin.org

27. 11 years in development 13 indicators initially; 25 currently 98% reporting rate in 3rd quarter 2011 Continually refining metrics & peer groups PIN Benchmarking Project

28. Sample report 8 quarters 5 Peer Groups

29. Clinical Improvement Studies Program Clinical Improvement Studies (CIS) 2 studies underway at all times Clinical Improvement Panel (CIP) 8 PIN Physician volunteers 2 PIN mid-level volunteers CIS Development Committee (CIS-DC) DON and QI/PI Coordinator volunteers

30. CIS Program 2011- 2012 Patient Safety: Prevent MRSA Transmission Surviving Sepsis Campaign guidelines Clinical Benchmarking Project o Pressure Ulcers, HF, CAP, Stroke, Inter-facility Transfer measures, Reduce Preventable Falls  adding HCAHPS, Feb 2012 PIN Quality Awards: 2012 recipient criteria o MBQIP participation; improvement made; share learning o You MUST apply to receive an award by Aug 1, 2012 !

31. PIN Lessons Learned Leadership commitment is essential Involve more than CEOs Clarifying program responsibility and accountabilities in the facility are essential (not just the coordinator) Frequent communication “What gets measured gets managed”

32. QUESTIONS? Cultural transformation is a slow, deliberate, strategic process.