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2024 Spring Flex/CAH Quality Network Newsletter

Items in this issue include:

Critical Access Hospitals Quality Network

Eight North Dakota Hospitals Recognized Among Top Critical Access Hospitals

Eight Critical Access Hospitals (CAHs) in North Dakota have been named to the Top 100 CAHs for 2024, according to The Chartis Center for Rural Health. Top 100 CAHs are top performers, excelling in financial efficiency, achieving higher quality, securing better outcomes, increasing patient satisfaction, and operating at a lower cost than their peers across the U.S.

North Dakota CAHs Recognized

Three Rural Hospital Chief Nursing Officers Receive Certification

Three directors of nursing (DONs) from three CAHs recently received leadership training from the National Rural Health Association's Center for Rural Health Leadership Program. Learn more.

Recap of the 2024 Flex Annual CAH & RHC Meeting

On April 17, CAH and Rural Health Clinic (RHC) leaders had the opportunity to attend a full day of educational leadership offerings. Attendees heard from a variety of presenters who spoke about transforming the culture of your hospital, telehealth resources, stay interviews for staff, and the top CAH and RHC deficiencies in North Dakota. In addition to the highly informative speakers, attendees were also provided with the opportunity to network and collaborate with their peers. The meeting was well attended with over 80 individuals who represented 31 of the 37 CAHs in the state. Participants expressed "appreciation for the hands-on tactics and strategies they were able to bring back to their facility."

Save the Date!

2025 North Dakota Flex Annual CAH and RHC Meeting
April 23 & 24, 2025
Bismarck Event Center
Bismarck, North Dakota

North Dakota Health Information Network Provides Valuable Service

The North Dakota Health Information Network (NDHIN) provides a statewide expanse of health information exchange across a secure network that includes a broad range of services. A key service, NDHIN leverages this comprehensive network to act as a data intermediary for electronic Public Health Reporting from participating organizations to share with North Dakota Health and Human Services.

As part of your facility's participation with NDHIN, you have access to the following services:

  • NDHIN Clinical Portal
  • Health Information Service Provider with Direct Secure Messaging services
    • Required for "Transitions of Care" under the CMS Medicare Promoting Interoperability Rule
    • Required for transmission of Electronic Case Reporting to CDC
  • Electronic Test Orders & Results
    • Allows for the ability to enter a lab order that routes to the North Dakota Public Health Lab and receive back the test result within the electronic health record
  • Electronic Public Health Reporting
    • Required by state and federal laws, as well as the CMS Medicare Promoting Interoperability Rule
    • Data feeds include:
      • Immunization Data
        • Routes data to NDHHS/NDIIS (North Dakota Immunization Information System)
        • Provides the ability to query through NDHIN to the NDIIS and receive back patient immunization records and forecasts of upcoming vaccination needs
      • Syndromic Surveillance Data
        • Routes data to NDHHS and CDC
      • Electronic Laboratory Reporting
        • Routes data designated as reportable conditions to NDHHS

Learn more about NDHIN.

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

  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
    Due date: July 3
  • Emergency Department Transfer Communication (EDTC)
    Due date: July 31
  • Outpatient, (OP-18) – Median Time from ED Arrival to ED Departure for Discharged ED Patients
    Due date: August 1

For questions or technical assistance please contact:

Rural Health Clinic Network

Upcoming PCM/TCM/CCM Webinars

The Flex team would like to invite you to a virtual webinar series on Principle Care Management/Transitional Care Management/Chronic Care Management (PCM/TCM/CCM), presented by Eide Bailly. Please note, all three sessions take place in the same week. We encourage you to attend as a team and to invite your billing and business staff, as they may also benefit from the content that will be shared.

Register for these sessions:

  • Session 1 – July 22 at 10 am Central
    CMS Requirements for Establishing PCM, TCM, and CCM
  • Session 2 – July 24 at 10 am Central
    Required Elements for Documentation for PCM, TCM, and CCM
  • Session 3 – July 26 at 10 am Central
    Brief Review of RHC Billing Requirements and Best Practices for PCM, TCM, and CCM

Five Rural Health Clinic Professionals Receive Certification

Five professionals representing four North Dakota Rural Health Clinics (RHCs) recently received leadership training from the National Association of Rural Health Clinics Certified Rural Health Clinic Professional Certification. Four of the participants were sponsored by the North Dakota Medicare Rural Hospital Flexibility (Flex) program. One participant was sponsored by the State Office of Rural Health (SORH). Flex and SORH are housed at the Center for Rural Health (CRH) within the University of North Dakota School of Medicine & Health Sciences.

The National Association of Rural Health Clinics Certified Rural Health Clinic Professional Certification is an eight-to-ten week online course with a proctored final exam. The program is designed to enhance knowledge to successfully run an RHC. The coursework includes topics such as scheduling, front office, and patient flow; internal controls; provider enrollment, cost reporting, revenue cycle basics, emergency preparedness, and many other areas. The individuals who earned the certification are:

Jody Ward, grant program director for Flex, said, "Having well-trained clinic leaders is an important aspect to running a successful Rural Health Clinic. We are proud to be able to provide this important education which will allow the clinics to continue to serve their communities at the highest levels of care."

Successful YR 2 RHC Financial and Operational Best Practices Meeting

On April 16, North Dakota RHC managers gathered for a presentation from subject matter expert Ralph Llewellyn of Eide Bailly on the RHC best practices related to the year two financial and operational indicators and corresponding benchmarks. Attendees reviewed and discussed the North Dakota Financial Indicator report from year two that was completed in August of 2023 and presented virtually in November of 2023. The presentation showed the comparison of year one and year two data for the 15 different financial indicators. Potential strategies were introduced to the attendees to help them improve their financial performance for each financial indicator within their RHC. A highlight of the session was the input and advice from fellow North Dakota RHCs that are performing well in the various financial indicators.

Financial/Operational Improvement Update

North Dakota Rural Path to Value Cohort

The Center for Rural Health (CRH) and the Flex Program continue to work on assisting North Dakota CAHs with the transition to value. In the current Flex year (September 1, 2023 – August 31, 2024), there are six North Dakota CAHs participating in a cohort of the Rural Path to Value program:

The Rural Path to Value program provides an opportunity to bridge a CAH's work in population health while working towards value. The North Dakota cohort runs October 2023 – August 2024 and is customized to support CAHs and RHCs taking early steps to adopt population health practices. Participants work with the Rural Path to Value team to design a population health-based project that's customized to the unique needs of the communities each CAH serves and can be implemented with available resources. The cohort has access to training, tools, and strategies to accomplish this, learn how to improve and sustain community partnerships and organizational planning projects, and how to help communities navigate the transition to population health.

Project components:

  • Completing a population health assessment
  • Personalized community data snapshot reports
  • Strategy identification workshop
  • Action planning workshop
  • Two education webinars
  • One-on-one support and coaching calls
  • Peer sharing calls

Cohort participants are currently implementing their action plans around the following self-identified populations:

  • Mountrail County Medical Center, Stanley: Building on an existing Chronic Care Management Program for patients with two or more chronic conditions, who frequently use the emergency room, or who are requested by a provider
  • Pembina County Memorial Hospital, Cavalier: Emergency Department Readmissions
  • Dakota Regional Medical Center, Cooperstown: Developing a Chronic Care Management program
  • Nelson County Health System, McVille: Dementia Care and Education
  • CHI St. Alexius Health, Carrington: Mental Health education and services for all ages
  • South Central Health, Wishek: Increasing Medicare Annual Wellness Visits

Learn more about the Rural Path to Value program.

North Dakota Critical Access Hospitals Receive Funds to Implement Projects

Seven North Dakota CAHs recently received funding to assist with implementation activities and financial/operational improvement areas. Read more.

Four North Dakota CAH Chief Financial Officers (CFOs) Participate in 2024 National Rural Health Association CFO Certification Program

Finance and Operations, one of the core Flex work areas, allows for a variety of outreach, education, and support to North Dakota's 37 CAHs. One form of support that began in June 2022 was the opportunity for Flex to support a portion of the registration fees for North Dakota CAH CFOs to participate in the CFO Certification Cohort from the National Rural Health Association (NRHA). Since June 2022, a total of 11 North Dakota CAH CFOs have participated in one of the annual cohorts.

The program, developed by successful rural CFOs for their peers, runs for 30 weeks with the intent of strengthening CFO leadership skills. The course curriculum focuses on the specific areas of leadership: operations, finance, and clinical. Upon successful completion of the cohort, CFOs will receive a two-year Rural Hospital CFO Certification.

For additional program information, visit NRHA's CFO Certification Program page.

Five CAHs Attended Financial Institute

The North Dakota Flex Program, provided funding for five North Dakota CAH representatives to attend the North Dakota Healthcare Financial Management Association Annual Institute in Bismarck this past February. Learn more.

Small Hospital Improvement Program (SHIP)

The FY23 SHIP funding year ran from June 1, 2023 – May 31, 2024. CAH SHIP contacts are encouraged to continue submitting reimbursement requests with supporting documentation of the approved SHIP activities at any time. A final report will be sent to CAH SHIP contacts at the conclusion of the SHIP year. The final report is important to show federal funders the importance and impact of SHIP funding to each facility.

FY24 SHIP (June 1, 2024 – May 31, 2025) subawards are anticipated to be sent to each CAH CEO for signature during the month of June. SHIP funding priority areas continue in FY24 and are: 1) hospitals must meet MBQIP participation requirements; and 2) implementing ICD-11 coding readiness and/or implementation activities. The priority areas must be addressed with tangible activities before working on additional SHIP eligible activities. The priority area activities do not have to utilize SHIP funds to be accomplished but must be addressed prior to being eligible for additional SHIP activities. This information is reflected in each CAH's subaward paperwork in the Scope of Work section.

For SHIP questions, contact Nicole Threadgold.

SHIP American Rescue Plan

A big thank you to all CAH contacts who were involved in their facility's SHIP American Rescue Plan COVID-19 Testing and Mitigation funding. After two and a half years, the funding closed December 31, 2023, and final reports are submitted! Thank you for your diligence in monitoring spending and responsiveness when completing the quarterly reporting.

Workforce Update

2024 Recruitment for Retention Academy

3RNET 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 in October and will continue through December. All sessions are available to attend live, or view on-demand as part of the registration. CRH is sponsoring the state's attendance to save each person $500 PER REGISTRATION!

Registration is not yet open for the 2024 Academy, but if you are interested in attending free of charge, please contact Stacy Kusler.

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.

CRH and Primary Care Office Partnership

The UND CRH has been a partner of the North Dakota Primary Care Office (PCO) since 2016. Through this partnership, our office assists with promoting and educating facilities and workforce about various loan repayment incentives available. The PCO is also home to our state's J-1 Visa Waiver program, which is managed by Stacy Kusler, workforce specialist at CRH. The PCO's mission is to improve primary care service delivery and workforce availability. The team at the PCO includes Kalee Werner, director; Natalie Jung, healthcare workforce manager, and Cody Cooper, data analyst. Kusler is part of the team as a contracted partner working on National Health Service Corps site certification and J-1 Visa Waivers. Learn more about how the PCO can help your rural or underserved community.

Immigration and Workforce Panel at the Dakota Conference

If you are attending the 2024 Dakota Conference on Rural and Public Health, be sure to catch the Immigration Staffing workforce panel on June 4 at 2:55 pm Central. Panelists will include Matthew Webster, senior immigration attorney for Fredrikson & Byron; Paige Kuntz, global talent coordinator for the North Dakota Office of Legal Immigration; Brock Sherva, CEO of Northwood Deaconess Health Center; and Alzandra Carmona, lab manager for Northwood Deaconess Health Center. This panel will share insights on various immigration pathways for healthcare workforce, as well as first-hand accounts of what it's like to navigate the immigration pathway to work in the U.S. The panel will answer prepared questions, as well as questions from the audience.

State Office of Rural Health

Dakota Conference on Rural and Public Health

The 2024 Dakota Conference on Rural and Public Health, taking place June 4-6, will be held in Grand Forks, North Dakota.

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 two- and one-half days of pre and post conference meetings, keynote speakers, breakout sessions, poster presentations, and an awards banquet.

The Rural and Public Health Awards Banquet will be held June 5, at 12:05 pm Central at the Alerus Center.

R-COOL-Health Scrubs Program Highlight

A memorable and effective method to grow the healthcare workforce is to introduce it to students while they are young. This is the idea behind the Rural Collaborative Opportunities for Occupational Learning in Health (R-COOL-Health) Scrubs Program. This program provides opportunities for students to learn about careers in healthcare directly from professionals in fun and interactive ways.

The R-COOL-Health Scrubs Program is funded by CRH and offers three different formats: Scrubs Academy I and Scrubs Academy II, four-day/three-night camps hosted on college campuses for students in grades 6-8 and 9-11, respectively, and Scrubs Camps, one-day camps hosted in rural communities.

First Care Health Center, located in Park River, hosted two Scrubs Camps for students in the surrounding area, including students from Valley-Edinburg School District, Fordville-Lankin Public School District, and Park River Area School District. First Care Health Center partnered with Back in Motion Chiropractic, Golden Valley Vet, Heartland Eye Clinic, Park River EMS, and Lifetime Dental to showcase a variety of different healthcare careers.

Health professionals presented different careers to the students and included engaging hands-on activities like drawing blood, mole excisions, suturing, chiropractic adjustments, and creating dental molds among other things to promote careers in the healthcare industry.

Scrubs Camp Grant Applications

Scrubs Camp grant applications are now being accepted for the 2024-2025 cycle and are due August 15 at 4:00 pm Central. Awardees will be notified on August 16. Camps can begin to take place September 3 and must be completed by April 30, 2025. Note that this timeline has been altered to allow for flexibility in the event of winter weather. Learn more about the grant guidance, see example documents, and submit the proposal.

National Rural Health Day

National Rural Health Day is November 21 and there are many opportunities for organizations to celebrate all things rural. Learn how you can show support, sign on as a supporter, and more!

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

  • June 11 – Medication Management
  • June 13 – North Dakota RHC Managers Meeting
  • June 20 – DON Networking Meeting
  • June 24 – Stroudwater – Health Equity Webinar: Data Collection/Analysis
  • July 17 – North Dakota RHC CfC Survey Sharing Meeting
  • July 22 – Stroudwater – Health Equity Webinar: Community Collaboration
  • July 22 – Eide Bailly – CMS Requirements for Establishing PCM/TCM/CCM
  • July 24 – Eide Bailly – Required Elements for Documentation for PCM/TCM/CCM
  • July 26 – Eide Bailly – Review of RHC Billing Requirements for PCM/TCM/CCM
  • August 6 – North Dakota RHC Network Quarterly Meeting
  • August 7 – Care Coordination Workshop
    Bismarck, North Dakota
  • August 13 & 14 – North Dakota Eastern & Western Region CAH Quality Network Meetings
  • August 14 – North Dakota RHC Managers Meetings
  • August 20 – North Dakota CoP Survey Sharing Meeting
  • August 22 – DON Networking Meeting

Presentations and Photos

Photos


The North Dakota Flex Team at the 2024 Flex Annual CAH & RHC Meeting. From left to right: Jody Ward, Nicole Threadgold, Anna Walter, Anahita Anvari-Clark, and Jodi Bosch.

Pictured are some CRH staff at the 2024 National Rural Health Association's Annual Rural Health Conference in New Orleans. From left to right: (back) Kali Gimse, Stacy Kusler, Nicole Threadgold, (front) Holly Long, Anna Walter, Jessica Rosencrans, and Anahita Anvari-Clark.

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 Jody Ward for login information.

Are You New to Your Role or Organization?

Please email Jody Ward, program director of the North Dakota Flex Program for a one-hour orientation on the Flex Program or the North Dakota CAH Quality Network and MBQIP Program. If you are a new RHC manager, please email Anna Walter, project coordinator, for a one-hour orientation on the North Dakota RHC Network.