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2024 Fall Flex/CAH Quality Network Newsletter

Items in this issue include:

Critical Access Hospitals Quality Network

Two North Dakota Hospitals Recognized Among Top Critical Access Hospitals

Two Critical Access Hospitals (CAHs) in North Dakota were named to the Top 20 CAHs for 2024, according to the Chartis Center for Rural Health. This elite group of hospitals was selected from the Chartis Center for Rural Health's 2024 top 100 CAH list, which was released earlier this year. Additionally, three CAHs were named to the Top 20 in Quality, and one CAH was named to the Top 20 in Patient Satisfaction, which are best practice designations.

North Dakota CAHs Recognized

Best Practice Recipients – Quality

Best Practice Recipients – Patient Satisfaction

Sanford Hillsboro Medical Center Receives Flex Quality Award

Sanford Hillsboro Medical Center received the Flex Quality Reporting Award at the 2024 Dakota Conference on Rural and Public Health. The award is given to a CAH in North Dakota who has developed an Antibiotic Stewardship Program to include all required elements and met the largest number of subcomponent measures. Antibiotic Stewardship Programs can help clinicians improve clinical outcomes and minimize harms by improving antibiotic prescribing. Dara Berdal and Marie Riemer received the award on behalf of Sanford Hillsboro Medical Center.

Regulatory Update

Centers for Medicare & Medicaid Services (CMS) recently published new fact sheets summarizing the Medicare rules and regulations for CAHs:

MBQIP Data Reporting Reminders and Resources

Upcoming Submission Deadlines:

  • November 22, 2024 – CAH Quality Infrastructure Assessment
  • January 2, 2025 – Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
  • January 31, 2025 – Emergency Department Transfer Communication (EDTC)
  • February 1, 2025 – Outpatient, (OP-18) – Median Time from ED Arrival to ED Departure for Discharged ED Patients

** Remember! The encounter period for HCP/IMM-3 (Influenza Vaccination Coverage Among Healthcare Personnel) began on October 1. Ensure that your facility has a process in place to record flu vaccinations, including those that decline the vaccine. You can find excellent resources at NHSN including instructions on how to complete the Healthcare Personnel Influenza Summary Form.

For questions or technical assistance please contact:

  • Anna Walter for EDTC, OP-18, OP-22, *CAH Quality Infrastructure Assessment, *Hospital Commitment to Health Equity
  • Anahita Anvari-Clark for HCAHPS, Antibiotic Stewardship, HCP/IMM-3, *Safe Use of Opioids, *Hybrid Hospital-Wide Readmission, *SDOH Screening, *SDOH Positive

*new MBQIP measures for 2025

Rural Health Clinic Network

Care Coordination Canvas Workshop

On August 7, a Care Coordination Canvas Workshop was held in Bismarck and facilitated by Debra Laine from Rural Health Innovations. There were eight CAHs/RHCs represented with a full team ready to learn the Care Canvas Framework to improve the care coordination efforts currently in place within their hospital and clinics.

The workshop aimed to provide an infrastructure to build or improve care coordination efforts for their facility. Participants completed pre work where they came with an intended population. They assessed its needs, understood the care plan, and analyzed the care team. The workshop introduced a process to identify and recognize the foundational role of social drivers of health.

The takeaways from the workshop for the participants were engaging in activities to enhance their ability to address their community's specific needs. They learned how to apply strategic frameworks, improve communication among team members, develop customized plans, and use techniques for ongoing improvement and evaluation.

Financial/Operational Improvement Update

Funding Opportunity – 2024 North Dakota CAH Subcontract Program

The North Dakota Flex Program will have upcoming funding available to support North Dakota CAHs through CAH Financial/Operational Improvement Area of Choice. Stay tuned for more information later this fall! When available, funding information and the online application can be found at Flex Funding Programs.

Small Hospital Improvement Program (SHIP)

The SHIP funding year runs 6/1/24 – 5/31/25 SHIP Funding Priority Areas continue this year and are:

  1. Consistently reporting MBQIP measures
  2. Implementing ICD-11 coding readiness or implementation activities

The priority areas must be addressed before working on additional SHIP eligible activities. This information is reflected in each CAH's subaward paperwork in the Scope of Work section. As the SHIP year progresses, continue working on your selected activities. If you encounter a barrier to implementing a selected activity, reach out to nicole.threadgold@und.edu as soon as possible to discuss options.

SHIP reporting continues to include: a mid-year check-in to see how CAH-selected activities are progressing; a final report to see progress of implemented activities; and reimbursement request once expenses are incurred. Look for communications regarding the mid-year check-in to be sent in December.

Workforce Update

2024 Recruitment for Retention Academy

The 2024 3RNET Recruitment for Retention Academy is available at no cost to all of our North Dakota healthcare facilities! This six-part webinar series began October 8 and will continue through December 17. If you missed the first few sessions, don't worry. All sessions are available to watch as part of your registration. The Center for Rural Health (CRH) is sponsoring our state's attendance to save you $500 PER REGISTRATION!

Register for the 3RNET Recruitment for Retention Academy. Enter your info and click "add to cart". It will say $500, but don't worry. On the next page, you will be able to add a coupon code CRH24 to remove the fee. Follow prompts for information, and you'll be all set!

3RNET PLUS TOOLS

If you are a user of 3RNET and are looking for a more efficient way to track candidate interactions, consider upgrading to a 3RNET PLUS TOOLS account!

3RNET PLUS TOOLS can keep you organized and streamline your recruitment process. Begin your free 30-day trial by upgrading your account. Reach out if you need any help navigating this process.

3RNET Refreshers Available

3RNET is a free and valuable resource available to rural and underserved communities across the state. If you haven't logged in lately, or feel like you could use a refresher on how best to use this site, reach out to Stacy and schedule a 30 minute refresher!

3RNET is your place for:

  • Free job postings
  • Direct referrals of candidates to your account (matching your job openings)
  • Promotion of open jobs at job fairs and presentations that Stacy attends
  • Recruitment and retention resources that are useful for new or seasoned recruitment professionals

Be sure to use your account to its fullest potential, and log in today!

3RNET Annual Conference Held in Bismarck in September

The 3RNET annual conference was held in Bismarck, North Dakota — a first for this conference! This national event attracted nearly 100 people from around the country, including network coordinators and supporting sponsors. This small, but mighty conference was 2 full days of content focused on the challenges, opportunities, and ideas for rural recruitment and retention success. As the host state, North Dakota was able to feature some of our own success stories to the crowd. Jocelyn and Darrold Bertsch presented on the value of 3RNET to their CAH and FQHC partnership organization. Residents from the Bismarck Family Medicine Residency program were featured on a panel along with their program director, Shannon Sauter, to discuss what residents are looking for in their first job. Finally, our North Dakota AHEC team shared their successes alongside the Montana AHEC team. We finished off the conference with a riverboat cruise on the Missouri River, and the infamous North Dakota football coach, and now-director of the North Dakota Historical Society, Dale Lennon, was our emcee for the cruise. It was an inspiring week that made us proud of all the partnerships and good work being done in North Dakota!

Four photos of various workforce events

2024 Primary Care Week

CRH and the American Medical Student Association (AMSA) hosted the 2024 Primary Care Week at the UND School of Medicine & Health Sciences the week of October 28 to November 1st. This annual event includes a full week of sessions to help students understand more about primary care professions. Sessions included a panel of primary care residency program directors and residents, a student-lead conversation about summer opportunities, and the Community Meet and Greet event to connect students with healthcare facilities from the state and region.

Full information about this year's event can be found on the Primary Care Week webpage.

State Office of Rural Health

Community Health Needs Assessments at CRH

CRH has a long-standing history of conducting Community Health Needs Assessments (CHNAs). CRH has the experienced staff and resources to guide you throughout the assessment process.

Your dedicated CRH CHNA lead and assistant are actively involved in all 11 steps of your CHNA process. Together with expert data and communications teams, they:

  • Prepare and submit UND Institutional Review Board documents for approval. This ensures the CHNA survey process is conducted in an ethical way protecting the rights and welfare of those participating in the survey.
  • Create a customized survey tailored to discover your community's health needs.
  • Organize and facilitate two community meetings (in-person) and 6-10 key informant interviews (in-person or virtual if needed).
  • Analyze your unique survey results, county-level health information, key informant and focus group data.
  • Create your final CHNA report, incorporating updated primary and secondary data and prioritized needs.

Coordination of all items throughout the 11-step process are facilitated via exclusive access to CRH's online eToolkit. The eToolkit is a central repository of tools and resources integral to conducting a successful CHNA. It is the primary communication tool between your CRH CHNA team and your facility's CHNA liaisons. Did you also know there is bonus eToolkit content to assist your liaisons in CHNA Implementation Planning? For more information contact holly.long@UND.edu.

Dakota Conference on Rural and Public Health will be June 17-19, 2025 in Bismarck

The 2025 Dakota Conference on Rural and Public Health, taking place June 17-19, will be held in Bismarck, North Dakota, and marks the 40th year of the Dakota Conference.

The Dakota Conference provides an opportunity for hundreds of healthcare professionals, educators, and students to share strategies for building and sustaining healthy communities in North Dakota. It includes pre and post conference meetings, keynote speakers, breakout sessions, poster presentations, and an awards banquet.

The Rural Health Awards are now open for nominations. Nominate someone for one of nine awards categories for outstanding commitment to rural communities. The Rural and Public Health Awards Banquet will be held June 18, at 11:50 pm Central at the Bismarck Event Center.

National Rural Health Day

National Rural Health Day is November 21! There are many opportunities for organizations to celebrate the Power of Rural. How will you celebrate on November 21? Sign up to show your support by November 20.

Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation Building Healthier Rural Community (BUILD) Grants Program

BUILD grants focus on transforming the health and well-being of rural North Dakotans and address the social determinants of health affecting its communities so we can build a better future of equity and full potential for all.

The program targets the following primary focus areas:

  • Economic stability
  • Education access and quality
  • Healthcare access and quality
  • Neighborhood and built environment
  • Social and community context

Keep an eye out on the project page for applications to open this fall. For more information contact Holly Long.

Upcoming Meetings

Looking for a particular meeting? Visit the North Dakota Healthcare Partners Events Calendar and search our upcoming events for more information and to register then add to your calendar.

Upcoming Flex Program, North Dakota CAH Quality Network, and RHC Network Meetings

  • November 12 – CfC Educational Webinar
  • November 18 – Year 3 RHC Financial/Operational Analysis Presentation (virtual)
  • November 19 – RHC Clinic Managers Meeting
  • November 21 – DON Networking Meeting
  • December 3 – North Dakota Eastern Region CAH Quality Networking Meeting
  • December 4 – North Dakota Western Region CAH Quality Networking Meeting
  • December 5 – Coding and Billing Education – CPT Updates and Changes
  • December 17 – RHC Clinic Managers Meeting
  • December 19 – DON Networking Meeting

Save the Date!

Presentations and Photos

Staff of the North Dakota Flex team were asked to present on various topics are recent state and national conferences.

  • Flex Senior Project Coordinator Nicole Threadgold co-presented with Crystal Barter, Director of Programs and Services of the Michigan Center for Rural Health at the 2024 Flex Program Reverse Site Visit in Washington DC. Their presentation is titled: Driving Change: Navigating ACO Support from the State Flex Program Perspective.
  • Flex Senior Project Coordinator Nicole Threadgold was invited to participate in the May 2024 Rural Health Workforce Summit hosted by the Technical Assistance and Services Center, a program of the National Rural Health Resource Center in collaboration with the Health Resources and Services Administration Federal Office of Rural health Policy. The report presents a framework that state Medicare Rural Hospital Flexibility Programs and other rural partners can use as a guide to address health workforce challenges. The report is titled Building a Sustainable Rural Health Workforce for the 21st Century: A Report of the 2024 Rural Health Workforce Summit.

Did You Know?

The Flex Program offers a variety of tools and resources in the Virtual Library. The Virtual Library is:

  • A free online repository of CAH-specific resources
  • A one-stop shop to locate resources, protocols, and best practices related to CAH quality
  • Maintained by the North Dakota CAH Quality Network

Email Anahita Anvari-Clark for login information.

Are You New to Your Role or Organization?

Please email Anna Walter or Anahita Anvari-Clark, for an orientation on the Medicare Rural Flexibility Program (Flex), MBQIP Program, the North Dakota CAH Quality Network, and the North Dakota Rural Health Clinic Network.