The Flex Program provides cost-based reimbursement for critical access hospitals (CAHs) through two components: state rural health plans and CAH certification. Originally, the program aimed to develop rural health networks and improve quality of care. Over time, more hospitals were certified as CAHs. Currently, CAHs make up 26% of community hospitals and 66% of rural hospitals. Quality reporting through measures like pneumonia and heart failure processes of care is increasing for CAHs.
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MBQIP 2011 Missouri
1. The Flex Program Medicare Beneficiary Quality Improvement Project Paul Moore, DPh Senior Health Policy Advisor Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy 2011 RURAL HOSPITAL CONFERENCE
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7. Sunset of Necessary Provider Waiver A State may designate a facility as a critical access hospital if the facility… is certified before January 1, 2006, by the State as being a necessary provider of health care services to residents in the area.
28. “… a hospital patient can expect on average to be subjected to more than one medication error each day.” July 20, 2006
29. Pharmacist Staffing and the Use of Technology in Small Rural Hospitals: Implications for Medication Safety Michelle M. Casey, M.S. Ira Moscovice, Ph.D. Gestur Davidson, Ph.D. December 2005 A partnership of the University of Minnesota Rural Health Research Center and the University of North Dakota Center for Rural Health
30. “ The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. Over one-third of the hospitals report having a pharmacist on site for less than 40 hours per week, including 31 hospitals where a pharmacist is on site for two hours or less per week .”
31. RUPRI Center for Rural Health Policy Analysis Rural Issue Brief Prevalence of Evidenced-Based Safe Medication Practices in Small Rural Hospitals Gary Cochran, PharmD Katherine Jones, PhD Liyan Xu, MS Keith Mueller, PhD April 2008
32. Prevalence of Evidenced-Based Safe Medication Practices in Small Rural Hospitals “ Approximately one in five of the nation’s smallest hospitals have… (1) a pharmacist review of orders within 24 hours…”
It's important to remember that the CAH designation was created to ensure access to high quality inpatient, outpatient and ER services to seniors in isolated area. Part of that is also attributable to the Flex program, which supports the CAHs. And we can point to at least 1,300 reasons why it is a public policy success. And while we've had lots of individual success stories, we still don't have the sort of national proof that quantifies this. We know that CAHs are more financially stable and that they're offering more services but at the end of the day we also ought to be able to say that we're improving the health of the population the designation and program were created to serve and that is the Medicare beneficiaries served by CAHs. So that's what this project is all about: Showing a national impact on the health of seniors served by CAHs. Because if we can't say that, it's hard to justify why we need the designation or the program.
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