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2025 Spring Flex/CAH Quality Network Newsletter

Items in this issue include:

Critical Access Hospitals Quality Network

Seven North Dakota Hospitals Recognized Among Top Critical Access Hospitals

Seven Critical Access Hospitals (CAHs) in North Dakota have been named to the Top 100 CAHs for 2025, according to The Chartis Group. 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

Recap of the 2025 Flex Annual CAH & RHC Meetings

The North Dakota Medicare Rural Hospital Flexibility (Flex) annual meeting was held on April 23 and 24, and CAH and Rural Health Clinic (RHC) leaders had the opportunity to attend two workshops and a full day of educational leadership offerings. On day one, RHC leaders spent the full day learning from Tressa Sacrey of Health Services Associate about RHC regulations and implementation strategies, administrative tasks, human resources and medical record audits, emergency preparedness and leadership and conflict resolution during the Practice Manager Workshop. Additionally, a half day Quality Workshop was held where attendees learned from Courtnay Ryan, of Telligen, on seven steps in strategic planning, data-driven decision making, and quality control. Attendees left the workshop with actionable next steps to take within their facility.

On the second day of the annual meeting, attendees heard from a variety of presenters who taught informal feedback skills and provided education on integrating quality improvement into your organizational culture, community health workers, quality strategies for rural success, 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 95 individuals who represented 32 of the 37 CAHs in the state.

Save the Date!

New Colonoscopy Capacity Map

Colorectal cancer is the second leading cause of death among cancers that affect both men and women. While there are multiple screening modalities, only one is appropriate for people at above-average risk for cancer: colonoscopies. Due to North Dakota's expanse of rural and frontier areas, access to screening by colonoscopy is limited. In addition, the number of available gastrointestinal surgeons and appointments for screening colonoscopies is low, often resulting in extraordinary wait times for colorectal cancer screening colonoscopies and diagnostic colonoscopies.

The Colonoscopy Capacity Map aims to address this barrier by identifying colonoscopy sites across the state, their approximate wait times, and their proximity to a prospective patient's physical location. The goal of this tool is to reduce the demand for screening colonoscopies at the larger hospitals and increase utilization at smaller, rural hospitals where there is significantly less demand and better access for rural residents. A representative of each facility is asked to update their data in the tool periodically by responding to a very short survey.

If you'd like to represent your organization and contribute data to this tool, contact the North Dakota Cancer Coalition (NDCC). If you're interested in learning more about this and other activities by the NDCC, consider joining us at the 2025 NDCC and North Dakota Colorectal Cancer Roundtable Annual Meetings on June 24 and 25, at the North Dakota Heritage Center and Museum in Bismarck.

Regulatory Update

Here are recently posted CMS memos for review and distribution. The most updated CMS policies and memos have been released.

MBQIP Data Reporting Deadlines

  • July 2 – Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
  • July 31 – Emergency Department Transfer Communication (EDTC)
  • August 1 – Outpatient, (OP-18) Median Time from ED Arrival to ED Departure for Discharged ED Patients

For questions or technical assistance please contact:

  • Anna Walter for EDTC, OP-18, OP-22, CAH Quality Infrastructure
  • Anahita Anvari-Clark for HCAHPS, Antibiotic Stewardship, HCP/IMM-3, SDOH-1 & 2, Hybrid Hospital Wide Readmission (HWR), Safe Use of Opioids

Rural Health Clinic Network

Flex Supported Four North Dakota Certified RHC Professionals to Attend National Association of Rural Health Clinics Spring Institute

The North Dakota Flex program financially supported four RHC leaders who were certified rural health clinic professionals to attend the NARHC Spring Institute in Oklahoma City this past March. This multi-day conference is dedicated strictly to RHCs and includes education valuable for rural health professionals of all kinds on topics such as cost reporting, chronic care management, emergency preparedness, updates on RHC rules and regulations, and more.

Jill Trostad, clinic manager at Northwood Deaconess Health Center, stated "I'm incredibly grateful for the generous support we received through the Flex program, which made it possible for me to attend this year's NARHC conference. It was an invaluable opportunity to grow professionally, connect with others in my field, and bring back valuable knowledge to our RHC."

Trostad continued, "One session that I always find especially helpful is on Emergency Operations Planning and Execution. In settings where resources and access to immediate support can be limited, understanding how to effectively prepare for and respond to emergencies is crucial. The insights I gained will help strengthen our clinic's preparedness plans, ensuring we meet compliance standards and improve our capacity to respond effectively during emergencies."

Successful Year 3 RHC Financial and Operational Best Practices Meeting

North Dakota RHC leadership and clinic managers gathered for a presentation from subject matter expert Greg Wolf, of Wintergreen, on financial and operational RHC best practices related to the year three financial and operational indicators and corresponding benchmarks. Meetings were hosted in the eastern (Carrington) and western (Bismarck) sides of the state. Attendees reviewed and discussed the North Dakota Financial Indicator report. The presentation showed a comparison of years 1-3 for the 15 different financial indicators. Potential strategies were introduced for 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 RHCs that are performing well in the various financial indicators.

Financial/Operational Improvement Update

North Dakota Rural Path to Value, 3-Year Behavioral Health Cohort

The University of North Dakota (UND) 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, 2024 – August 31, 2025), there are four North Dakota CAHs participating in a 3-year cohort of the Rural Path to Value project focused on creating, improving, and /or expanding a behavioral health program at their hospital. Through working with a subject matter expert, the CAHs are developing knowledge and skills to address identified behavioral health gaps in the communities they serve. The goal is to sustain a program around behavioral health in their communities. Thank you to the following participants:

North Dakota CAHs Received Funds to Implement Projects

Seven CAHs recently received funding to assist with financial/operational improvement projects. They include:

Flex Supported 13 CAHs To Attend Eide Bailly Annual Conference

The Flex program financially supported 13 North Dakota CAHs to attend the Eide Bailly Annual CAH Conference in Omaha, Nebraska, in March. This multi-day conference provided education on multiple topics such as cost report details and strategy, revenue cycle hot topics, financial toolkit for CAHs, CDM and Pricing, and collaboration between CAHS. Several of the North Dakota CAH attendees were first time attendees and voiced the value in education and networking the conference provided to them.

Small Hospital Improvement Program

The FY24 Small Hospital Improvement Program (SHIP) funding year runs from June 1, 2024 – May 31, 2025. 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 impact of SHIP funding to each facility.

For SHIP questions, contact Nicole Threadgold.

Workforce

Free Webinar: Building a Dynamic Sourcing Plan for Safety Net Facilities

This is the second webinar in two-part series offered by 3RNET for free through CRH.

CRH is proud to partner with 3RNET to bring you the Recruiting for Retention Webinar series. The first session took place in February and is available for viewing. The second session will take place on Friday, June 6, at 11:00 am Central. Registration is now open.

Session Description: Building a dynamic sourcing plan is an essential first step in finding and recruiting quality candidates for rural and urban-underserved safety net facilities. Today's environment demands that we fine-tune and adapt trusted avenues and explore new sourcing strategies to compete in finding in-demand and short-supply health professionals. We will cover tried and true sourcing strategies, identifying new sourcing channels, utilizing free and low-cost budget-saving tactics, building and implementing a successful sourcing plan, as well as valuable tips and tactics to track your efforts and strengthen your candidate pool of physicians and other health professions.

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 to Stacy Kusler if you need help navigating this process.

National Health Service Corp New Site Applications Open Through June 17

CRH has been a partner of the North Dakota Primary Care Office since 2016. Through this partnership, our office assists with promoting and educating facilities and workforce about various loan repayment incentives available, including National Health Service Corp (NHSC). Your site may be eligible to become a certified NHSC site so that you can offer NHSC loan repayment to your eligible workforce. If your site is not currently certified, and you meet all eligibility requirements, you can apply to be a site between now and June 17. If you have questions, please reach out to Stacy Kusler after you have read the NHSC Site Reference Guide.

Year 1 of the Nursing Community Apgar Project Nears Completion

CRH has been involved with the Community Apgar Project (CAP) since 2010. CAP is a research-validated questionnaire used to assist rural hospitals in North Dakota identify strengths and challenges related to recruiting and retaining various types of health workforce. Originally, the CAP process and methodology was utilized in North Dakota to look at what makes a community healthcare facility attractive to family medicine physicians. In recent years, the project evaluated what makes a community healthcare facility a good educational campus for health professions education through a tool called the Health Professions Education in Rural Communities, and what factors impact the recruitment and retention of CEOs in rural hospital communities.

Currently, the Nursing Community Apgar is evaluating 50 factors related to recruiting and retaining nurses. Fourteen rural CAHs are participating. Year 1 data is nearly complete, and Year 2 will begin in January of 2026. A report of Year 1 findings will be presented by Dr. David Schmitz, UND Center for Family and Community Medicine, and Stacy Kusler, workforce specialist at CRH, at the 2025 Dakota Conference on Rural and Public Health.

State Office of Rural Health

Dakota Conference on Rural and Public Health Will Be June 17-19, in Bismarck

The 2025 Dakota Conference on Rural and Public Health, taking place June 17-19, will be held in Bismarck, North Dakota.

Celebrating its 40th year, 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. The conference includes four keynote addresses, 20 sessions, four intensive sessions, and health policy and workforce panels, and an awards banquet.

The Outstanding Rural Health Awards at the Dakota Conference on Rural & Public Health will be held June 18, at 11:50 am Central at the Bismarck Event Center.

R-COOL-Health Scrubs Program Highlights

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 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.

The 2024-2025 school year included 10 Scrubs Camps:

The 2024-2025 Scrubs Camps involved over 119 North Dakota communities, served over 1,089 students, and had 309 volunteers. Health professionals presented a variety of 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

Interested in coordinating and hosting a 2025-2026 Scrubs Camp in your community? Scrubs Camp grant applications are now being accepted for the 2025-2026 cycle and are due August 15 at 4:00 pm Central. Awardees will be notified on August 21. Camps can begin occurring on September 2 and must be completed by April 30, 2026. Learn more about the grant guidance, see example documents, and submit a proposal.

National Rural Health Day

National Rural Health Day is November 20, and there are many opportunities for organizations to celebrate all things rural. Learn how you can show support.

Blue Cross Blue Shield of North Dakota Caring Foundation

The Building Healthier Rural Community (BUILD) Grants Program is a partnership with local providers and community-based organizations, the Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation, and CRH. The program seeks to build relationships and work collaboratively to understand, identify, and address the social determinants of health (SDOH) needs affecting the health and well-being of North Dakota communities. Financial support is awarded to those applicants whose proposals benefit rural North Dakotans, and their communities, by embracing SDOH solutions. The goal of these grants is to build a future of equity and full potential for health and well-being for all.

The awardees for the 2025 grant cycle include:

Applications for the BCBSND BUILD Grant Year 26 will be available in November 2025.

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/RHC Network Meetings

  • June 3 – Quarterly HCAHPS Learning Session #3
  • June 5 – Coding and Billing Education: HCC Risk Adjustment Documentation and Coding Webinar
  • June 10 – CoP Education Webinar – Medication Compounding/USP 797 – Nash Consulting
  • June 10 – Clinic Manager Meeting, North Dakota RHC Network
  • June 11 – New MBQIP Measure: Hybrid Hospital-Wide Readmission (HWR)
  • June 11 – CfC Education Webinar – Mastering RHC Reimbursement: Updates, Cost Reporting and Strategic Compliance
  • June 24 – Mastering the New HCAHPS by CLS
  • June 26 – DON Networking Meeting
  • July 10 – Coding and Billing Roundtable: Q&A and Best Practices for Physicians and Providers
  • July 17 – RHC Network Advisory Meeting
  • Aug 5 – Eastern & Western CAH Region Meeting
  • Aug 7 – Coding and Billing Education – Front Office Staff Training
  • Aug 11 – CfC State Survey Sharing Meeting – RHC Network
  • Aug 13 – EDTC Cohort – Final Meeting
  • Aug 14 – CoP State Network Survey Sharing Meeting – CAH Quality Network
  • Aug 19 – Clinic Manager Meeting – RHC Network
  • Aug 21 – DON Networking Meeting
  • Aug 26 – Quarterly HCAHPS Learning Session #4
  • Aug 27 – CAH Quality Network Advisory Meeting
  • Aug 28 – Quarterly Meeting #4: Flex CAH-owned EMS Cohort

Photos & Presentations

The North Dakota Flex Team at the 2025 Flex Annual CAH & RHC Meetings.

From left to right: Anahita Anvari-Clark, Jody Ward, Jodi Bosch, and Anna Walter.

Did You Know?

One of the tools of the Flex Program is the Flex Virtual Library. It provides:

  • A free, password-protected, online collection of recent North Dakota CAH and RHC-specific protocols, policies, and best practices.
  • Recordings of education webinars related to Conditions of Participation, State Survey sharing, MBQIP, and more.

Email Anahita Anvari-Clark clinical project coordinator, for your facility's login information and how to access the library.

Are You New to Your Role or Organization?

Please email Anna Walter or Anahita Anvari-Clark, for a one-hour orientation on the Flex Program, the 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 RHC Network.