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Annual Report

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Michigan Center for Rural Health

2016

Annual Report

VISION

MISSION

“The Michigan Center for Rural Health will be universally recognized as the center for expertise for rural health in Michigan through creative and visionary education, service, and research.”

“To coordinate, plan, and advocate for improved health for Michigan’s rural residents and communities.”

MCRH History

Michigan Center for Rural Health (MCRH) is a non- profit formed in 1991

Located on the campus of MSU in the College of Osteopathic Medicine

Organized on a directorship basis.

Governed by a Board of Directors

Key role in rural health care by  assisting in the creation and implementation of partnerships among non-profit groups, health departments, hospitals, government, and academia.

Provides the 'rural' perspective to many organizations, associations, and committees to help ensure effectiveness in delivering effective programs to Michigan's residents at the local and national level

STAFF

John Barnas

Crystal Barter

Rachel Ruddock

Emma Smythe

Isabella Ouellette

Rebecca Mickow

Sara Wright

Victoria Lantzy

Executive Director

Director of Performance Improvement

Recruitment & Retention Manager

Rural Health Improvement Coordinator

Rural Education Manager

Administrative Assistant

Administrative Assistant

Rural Health Programs Coordinator

Jeff Nagy

Quality Improvement   Advisor

SERVICES PROVIDED

Emergency Medical Services Programs

Continuing Education

Hospital & Rural Health Clinic Programs

Communications

Recruitment & Retention Services

Community Programs

Programs Managed include:

State Office of Rural Health

Medicare Rural Hospital Flexibilty Program

Small Hospital Improvement Program

Practice Transformation Network

Two Rural Accountable Care Organizations

Health Improvement Initiative Network

Quality Payment Program

Held April 21- April 22 at Soaring Eagle Casino & Resort.  

Annual Rural Health Conference

Nine COM and CHM students received rural conference scholarships

Rural Health Professional of the Year in honor of Loren O. Gettel was awarded to Brian Brasser,MSA, BSN, RN, FACHE, President, Spectrum  Health United and Kelsey Hospitals.

Sessions: Care- Connected Communities in Rural Healthcare, Improving Access to Care Using  Telemedicine, RHC Survey Process Common Deficiencies, Revitalize the Health & Vitality of your Community, and many more.

282  Attendees & 40 Exhibitors

Held on November 10-11, 2016  at Shanty Creek Resort

Critical Access Hospital Conference

175 Attendees & 27 Exhibitors

Who attends: Administrators, quality managers, network partners, & organization partners

Sessions: The Rural Hospital Landscape, Rural EMS in Michigan: Meeting Unique Challenges/Trauma  System Update,  Health Law Update, and more

GRAND ROUNDS

Live Video/Audio Conferencing hosted throughout rural MI with REMEC, UPTN, SWTH

Thirty-two programs held in 2016 and 16 of them were Webinars

Partners: MSU College of Nursing, MSU School of Social Work, MSU Department of Psychiatry, Geriatric Education Center of Michigan, Michigan Association of Ambulance Services, Mobile Medical Response, Michigan  Association  of Dental Hygienists, Ferris State University, MDHHS Oral Health Programs, ISC, and Hall Render Killian Heath & Lyman Law Firm

EMERGENCY MEDICAL SERVICES

April 30- May 1, 2016: Level III 18 participants March 19-20, 2016:  Level II 21 participants October 8-9, 2016: Level IV 16 participants

55 Total Participants

EMS Webinars

Hypothermia: 43 participants Burn Care: 31 participants Heat Related Injuries: 24 participants Pediatrics: 27 participants Asthma: 18 participants

143 Total Participants

EMS Leadership Academy Workshops

RURAL AED GRANT

The goal of the Michigan Rural AED Grant Program is to place AEDs in the most appropriate and useful locations as determined by the local Medical Control Authority (MCA) and the local EMS systems.   One-hundred thirty-five AEDs were distributed this last grant cycle; for a total of 356 AEDs distributed through the three year grant.

RECRUITMENT & RETENTION  

Resource for questions regarding recruitment, retention, loan repayment programs, visa programs and medical professional development.  

Participates in policy development and acts an advocate for recruitment initiatives with agencies that improve access to healthcare in rural Michigan.

Provides recruitment services to rural facilities (hospitals, RHCs and FQHCs) at little or no cost

T

echnical Assistance

P

resentations

Loan Repayment Programs

1. National Health Service Corps 2. State Loan Repayment Program 3. J-1 Waiver/ Conrad 30 Program 4. HHS Waiver Program

Presentations on SLRP and jobs in rural Michigan to over 800 medical, dental, NP, PA, and LMSW students at:

1. University of Detroit Mercy 2. Central Michigan University 3. Western Michigan University 4. Wayne State University 5. Michigan State University- CON 6. Michigan State University- COM 7. Michigan State University- CHM 8. Saginaw Valley State University 9. Grand Valley State University

MEDICAL STUDENT ACTIVITIES

Great interest in  rural medicine from students

National Primary Care Week- University of Michigan- FMIG with Dr. Karen Luparello from Hillsdale Hospital MSU COM- Dr. Don Edwards presented on Rural Emergency Medicine Mass Casualty Incident Events with ACOFP MSU CHM- Open invitations to CHM students to attend Rural Road Trip and Breakfast; found rural physicians for Specialty Seminar Series Wayne State University- Arranged for Dr. Mark Hamed from McKenzie Health System to attend a lunch and learn with medical students Capital Area Physician Experience Dine Around Table Mentor

RECRUITMENT & RETENTION EVENTS  

Rural Breakfast

Rural Roadtrip

OsteoCHAMPS

1

2

3

1. Eighteen first & second year MSU COM & CHM students had breakfast  with Dr. Kim Suhanic from Manistique Lakes Rural Health Clinic in Curtis, MI. 2. Fourteen first & second year MSU COM & CHM students visited Sparrow Carson Hospital and Center for Women's Healthcare. They met with with Dr.'s Seals, Heald, & Becher. 3. MCRH provided 5 scholarships to rural high school junior and seniors to attend OsteoCHAMPS at MSU COM.

MICHIGAN RURAL HEALTH CLINICS

- There are 185 Rural Health Clinics (RHCs) in Michigan

What MCRH provided:

1. RHC Practice Management Workshop        -51Participants 2. RHC Financial Management Workshops        -Three Workshops        -74 Participants 3. ICD-10 Billing and Coding Bootcamp        - One and half days.        -240 participants        -two  follow up webinars 4. Support for RHC Quality Network 5. Lean Analysis for RHCs 6. Remote Operational Assessment Tool

RHC Quality Network: Quarterly Meetings

1. Core Measure Discussion -Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (NQF #0028) -Controlling High Blood Pressure (NQF #0018)         -Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (NQF #0421) 2. Subject matter expert presentation     3. Best practices surrounding quality improvement in Michigan RHCs (presented by RHC staff)   4. Round table discussion on any issue related to RHCs

MICHIGAN RURAL HOSPITAL PROGRAMS

Since January 2001, the MCRH, the Michigan Peer Review Organization (Michigan’s QIO), Michigan Health & Hospital Association (MHA) and Michigan’s Critical Access Hospitals have worked together through the Michigan Critical Access Hospital Quality Network (MICAH) to create and implement a horizontally integrated coalition that supports the collection and analysis of health care data from the patient populations in order to achieve improved health outcomes in their respective rural communities.

During the 15-year history of the MICAH, voluntary membership has grown from the original 14 members in 2001 to 39 members (three members are rural PPS hospitals).

Core Areas of the Flex Program

1. Quarterly MICAH QN meetings 2. Benchmarking MICAH QN  Core Metrics and Medicare Beneiciary Quality Improvement Project  Metrics 3. Critical Access Hospital Annual Survey 4. Clinical Education 5. Critical Access Hospital Annual Meeting 6. Technical Assistance

1. HCAHPS data collection 2. Comprehensive Advanced Life Support (CALS) Training 3. EMS Webinars 4. EMS Leadership Academy

1. Supporting two CAH CFO Network meetings 2. Annual Financial Data Collection & Benchmarking 3. Financial Improvement Education 4. Operational Improvement Technical Assistance 5. Financial Support for Monthly Web Based Data Collection 6. Board of Directors Education & Training 7. Billing & Coding Education 8. Michigan Critical Access Conference

upport for Population Health & EMS Integration

S

S

S

upport for Quality Improvement

upport for Operational & Financial Improvement

MCRH manages Michigan’s Medicare Rural Hospital Flexibility Program, commonly referred to as the “Flex” program. Provides services to 36 Critical Access Hospitals (CAHs) , the Flex Program also assisted 289 rural EMS agencies and 10 rural PPS hospitals.

GREAT LAKES PRACTICE TRANSFORMATION NETWORK (GLPTN)

Three-state coalition of 32 healthcare partners (MI, IN, IL) Goal of transforming the practices of 11,500 clinicians across Indiana, Illinois, and Michigan into learning practices capable of providing better health and improved care at a lower cost Train and deploy 52 Quality Improvement Advisors (QIAs)

QIAs will provide direct technical assistance in: 1. Meaningful Use 2. Physician Quality Reporting System 3. Local quality improvement efforts to help prepare clinicians for participation in      value-based payment systems.

The network will utilize a “Transformational Change Toolkit" to integrate three practice transformation approaches: 1. Implementation Science, which is an emerging second generation of continuous quality improvement 2. Lean and Six Sigma process improvement tools 3. Patient-centric, personalized population health management.

QUALITY IMPROVEMENT ADVISOR (QIA) GREAT LAKES PRACTICE TRANSFORMATION NETWORK (GLPTN)

1. Recruitment 2. Practice Assessment Tool (PATs) 3. Action Plans 4. ZOHO 5. MACRA/MIPS     A. Education     B. PQRS          1. Selection Measures          2. Feedback Reports          3. QRUR Reports 6. Help practices understand and align their quality improvement focus areas with existing incentive and reporting  programs with goals of improving providers existing processes, and maximizing receipt of incentives. 7. Workflow evaluation and coaching to improve office and clinical efficiencies. 8. CME/MOC Part IV Programs in medication adherence and depression screening 9. Preparing the practice for upcoming changes in reimbursement (MIPS 2019) 10. Focused quality improvement efforts chosen from but not limited to:       - Medication Management       - Flu Vaccination       - COPD and CHF Management       - Depression Screening & Follow-up       - Diabetes Management       - Other, Practice identified priorities for clinical quality improvement

LEAN AND SERVICE LINE ASSESSMENTS

Sixteen Service Line Assessments were completed for RHCs and Hospitals.

RHCs 1. Allegan General Hospital 2. Sheridan Community Hospital 3. Helen Newberry Joy Hospital 4. Deckerville Community Hospital 5. McKenzie Health System 6. Mackinac Straits Health System 7. Lakeland Health System

Department Projects 1. Hayes Green Beach- Urgent Care 2. Sheridan- Operating Room 3. Sparrow Clinton- Surgery Care Delivery 4. Sparrow Ionia- Surgery Referral Process 5. Caro Community Hospital- Refresh 6. Aspirus Iron River- Emergency Department 7. Sheurer Health Network- Business Office 8. Mackinac Straits Health System- Radiology

Focus on operational & financial performance improvement areas:   -Margin management- revenue cycle optimization   -Competitive positioning   -Program development & growth opportunities   -Productivity improvements   -Identify operational changes required to improve performance   -Labor utilization and staffing model assessment Contains feedback relating to quality, service, and cost improvement opportunities Evaluation of organizational & management structure will be included as part of each service line analysis Each assessment/analysis will also contain key benchmarking information so target hospitals can compare their performance and current state to other, similar organizations.

ACCOUNTABLE CARE ORGANIZATIONS

Medicare Shared Savings Program (MSSP) is a new permanent program under Medicare that allows providers to continue to paid fee-for-service and/or cost-bast reimbursement, while gaining the infrastructure, tools and knowledge to manage population health. Groups of health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. Goal of coordinated care is to ensure that patients, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Meet eligibility requirements and submit application to CMS

ACO INVESTMENT MODEL

Developed in response to stakeholder concerns suggesting that some providers lack adequate access to the capital needed to invest in infrastructure necessary to successfully implement population case management 10,000 or fewer beneficiaries for the most recent quarter, as determined in accordance with the Shared Savings Program regulations No financial cap The ACO does not include a hospital unless the hospital is a critical access hospital (CAH) or inpatient prospective payment system (IPPS) hospital with 100 or fewer beds Target new ACOs serving rural areas and areas of low ACO penetration Quality of the spend plan in application Three Year Demonstration Project

MCRH'S ROLE

Greater MI Rural ACO

Southern MI Rural ACO

1. Sheridan Hospital 2. Scheurer Hospital 3. Hills & Dales General Hospital 4. Marlette General Hospital 5. McKenzie Health System 6. Helen Newberry Joy 7. Schoolcraft Memorial Hospital 8. Dickinson County Hospital

1. Hayes Green Beach 2. Sturgis Hospital 3. Three Rivers Health 4. Hillsdale Hospital 5. Coldwater Hospital 6. Allegan Hospital 7. Memorial Medical Center 8. Deckerville Community Hospital 9. Bronson South Haven

State-Based Executive Director Bi-weekly calls & weekly calls with providers Monitoring "to dos" Support information dissemination with weekly webinars Meeting support Liaison between two ACOs

MCRH COMMUNICATIONS

Quarterly newsletters on  current federal and state information, educational & funding opportunities, and other services.  Provides up to date information on Critical Access Hospital Programs and EMS Programs.  Use email marketing software and are able to drive content to specific audiences.

Multiple listserves allow MCRH to serve as Clearinghouse for state & federal information on data, grants, studies, surveys, briefs, and updates.   We use general listserves for announcements, reports; specialized listserves for Critical Access Hospitals, Rural Health Clinics, Chief Financial Officers, and Chief Nursing Officers, ACOs, etc.

Bi-weekly snapshots highlight current events, programs, and funding opportunities. Sent out every 2 weeks to specific audiences using the email marketing software.

ISTSERVES

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N

L

EWSLETTERS

NAPSHOTS

Celebrated National Rural Health Day on November 17, 2016

Created to celebrate the uniqueness of rural citizens and the rural healthcare environment.

 MCRH staff distributed apples and granola bars along with information about National Rural Health Day and MCRH.

Web-based tracking system that allows users to add, update and report activities and their impacts using a series of easy forms. In 2016, we provided technical assistance to 986 organizations (15 minutes or more) that covered nearly all of Michigan.

Michigan Center for Rural Health

Statements of Activities for the Years Ended September 30, 2016 and 2015

BOARD MEMBERS

Senator Geoff Hansen Michigan State Senate Edward Canfield, D.O. Michigan Osteopathic Association Kathy Wahl, BS, MSN, RN Michigan Bureau of EMS, Trauma and Preparedness Alfonso C. Ferreira, M.D., President Michigan State Medical Society Beth Nagel Michigan Department of Health and Human Services, Policy and Planning David B. Jahn, President & CEO Michigan Health & Hospital Association  

Nicholas Derusha, MPA, REHS, CFPH Michigan Association for Local Public Health Representative Sue Allor Michigan House of Representatives Nancy L. Spencer Michigan Primary Care Association William D. Strampel,D.O.,  Dean MSU College of Osteopathic Medicine Thomas J. Veryser, D.D.S, M.H.S.A. Office of the Governor Michigan Nurses Association Vacant