Montana Rural Hospital Flexibility and Rural Healthcare Performance Improvement Network Orientation Program June 201

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Some regular acronyms

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Montana Rural Hospital Flexibility and Rural Healthcare Performance Improvement Network Orientation Program June 2011

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Some normal 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-revenue driven arm of MHA = MT Hospital Association

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

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Montana's Flex Program MT Grantee = DPHHS Quality Assurance Division Jeff Buska , Administrator Kathy Lubke , Program Officer DPHHS contracts with MHREF to oversee Flex financed exercises DPHHS holds program assessment and monetary administration obligations Flex give year keeps running from September 1 through August 31

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Flex Director Carol Bischoff 457-8016 carol@mtha.org Rural Hospital Quality Coordinator Kathy Wilcox 461-6186 kathy@mtha.org Flex/PIN Staff

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

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Flex Grant Core Areas 2010-2011 Quality Improvement Operational and Financial Improvement Health System Development and Community Engagement

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Flex Grant Activity Sampler Core exercises QA/QI/PI: CoP help and other quality based tasks: benchmarking, clinical change & benchmarking, quality training & bolster arrange Meetings: CEO x 2, DON Forum, QI Showcase, Champions for Quality, Regional QIC/DON Coding workshops Other ventures differ from year to year CAH CFO organizing alternatives HIT online asset book Facility particular monetary effect reports Cost report survey Leadership Institute Lean temporary positions PIN site THE LIST IS ALMOST ENDLESS!

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Goal #1-Support endeavors to enhance and manage nature of care Continue Clinical Improvement Studies (CIS) CIS Lunchtime Learning CAH Peer audit Credentialing instruction Benchmarking/Clinical benchmarking Networking Meetings PIN site PI/QA/QI Education and assets Prevent Transmission of MRSA synergistic w/QIO, DPHHS Maintain HIT site HIT Training

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The Flex Medicare Beneficiary QI Project … otherwise known as MBQIP! Forerunner to esteem based buying for CAHs? Stage 1 Measures (one-year time allotment 2011-2012) Pneumonia: Hospital Compare CMS Core Measures Congestive Heart Failure: Hospital Compare CMS Core Measures Phase 2 Measures (one-year time allotment 2012-2013) Outpatient 1-7 as indicated in Hospital Compare (AMI-ED, SCIP) Hospital Consumer Assessment of Healthcare Providers and Systems  Phase 3 Measures (one-year time period 2013-2014) Pharmacist Review of Orders Outpatient Emergency Department Transfer Communication

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Goal #2-Support endeavors to enhance Montana CAH monetary and operational execution Meetings: Administrator, Nursing Directors Coding workshops CFO Networking Medical need assurance (RAC) Explore capital financing alternatives Leadership Institute Lean temporary positions

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Goal #3-Support endeavors to help CAHs in creating frameworks of care, tending to group needs GEMS-Geriatric Emergency Medical Services CHSD-Community Health Services Development Year 5-Needs evaluation and group social insurance arranging Fallon Medical Center in Baker, Madison Valley Hospital in Ennis, Holy Rosary in Miles City, Dahl Memorial in Ekalaka , Rosebud Health Care Center in Forsyth, Prairie Community in Terry and Clark Fork Valley Hospital in Plains MT Rural Health Plan

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Flex Networking/Ed Activities 2010-2011 Champions for Quality 2011 "Back to the Future" July 14-16, 2010 Great Northern Hotel Helena Medical Education, CMEs, Nursing CE credits 100% say this gathering is justified regardless of their opportunity to go to! Lunchtime Learning: another open door for supplier instruction

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Flex Networking/Ed Activities 2011 CAH Administrators Billings Sept 21, 2011 Joint QI Coordinators & DONs Regional Meetings Oct 2011; dates & areas to be declared CAH Administrators Jan 2012 DON Forum March 2012 QI Showcase, Fairmont April 2012

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Flex Networking/Ed Activities 2010-2011 Coding workshops: 5 th year! CFO Networking: ListServe; HFMA participation Credentialing: MTAMSS Conference June 2011

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Sustainable Leadership 2010-2011 Leadership Institute Lean Process Management North Valley Hospital, Whitefish Northern Rockies, Cut Bank Broadwater Health Center, Townsend McCone County Health Center, Circle Rosebud Health Care Center, Forsyth Fallon Medical Center, Baker

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Flex HIT Support Activities 2010-2011 HIT Technical Assistance site www.mtpin.org HIT Resource Guide Username MT CAH48 Password HIT Resource HIT Education Programs HIT Certification Program-MT Tech, Butte IT/HIT Literacy-Helena College Of Technology

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Significant Flex assets bolster the Montana Rural Healthcare Performance Improvement Network (PIN)

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Performance Improvement Network Formed at demand of CAH CEOs in 2001 All 48 MT CAHs are individuals Governance gave by PIN Advisory Board up to 10 individuals: CEOs, DONs, QI/PI Clinical oversight gave by the Clinical Improvement Panel (CIP)

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Performance Improvement (PI) Program C-0191 Agreements with qualified entities C-0195 Agreements for Credentialing and Quality Assurance C-0271 Clinical arrangements and methodology

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Performance Improvement (PI) Program C-0330 "Periodic Evaluation", ie, the Annual CAH Program Evaluation C-0336 "An compelling QA program": the desire of quantifiable improvement C-0337 All patient care and different administrations affecting tolerant wellbeing and safety are assessed

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Performance Improvement (PI) Program C-0338 Includes nosocomial diseases and drug treatment C-0339 Includes quality and appropriateness of analysis and treatment (ie, " peer audit ") C-0341 Considers discoveries and recommendations from the QIO and makes restorative move C-0342 Takes suitable medicinal activity to address inadequacies discovered through the QA program (ie, CAH overview insufficiencies)

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Performance Improvement (PI) Program Provides bolster for in-house PI staff Opportunities for enhancing execution Clinical change considers, clinical benchmarking Education, preparing and PI assets PIN Education Committee Regulatory data and support (CMS) Tag by label survey; fourth Wed every month, 2 pm

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Performance Improvement (PI) Program Support for in-house staff, cont. Discussion on location as asked for Networking openings supported gatherings Engaging organization and restorative staff Administrator gatherings; Champions for Quality; clinical change board and studies

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Facility Staff Support Resources "Best Practice" instruments, assets and instruction PIN ListServ pin@astro.lyris.net Quarterly PIN pamphlet PIN site www.mtpin.org

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PIN Benchmarking Project 11 years in the advancement 13 markers at first; 25 right now 94% detailing rate in first quarter 2011 Continually refining measurements & peer bunches

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5 Peer Groups Sample report 8 quarters

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Clinical Improvement Studies Program Clinical Improvement Studies (CIS) 2 concentrates in progress at all circumstances Clinical Improvement Panel (CIP) 8 PIN Physician volunteers 2 PIN mid-level volunteers CIS Development Committee (CIS-DC) DON and QI/PI Coordinator volunteers

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CIS Program 2011 Patient Safety : Prevent MRSA Transmission Pediatric Emergency Care: finished May 2011 Clinical Benchmarking Project Pressure Ulcers, HF, CAP, Stroke, Inter-office Transfer measures, Reduce Preventable Falls Quality Awards: 2011 beneficiary criteria Applications due August 1, 2011 You MUST apply to get a honor!

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PIN Lessons Learned Leadership duty is basic Involve more than CEOs Clarifying project obligation and accountabilities in the office are basic (not recently the facilitator) Frequent correspondence "What gets measured gets oversaw"

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Cultural change is a moderate, consider, vital process. QUESTIONS?

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