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Rural Hospital Flexibility Program Tracking Project

Appendix A
Dissemination of Rural Hospital Flexibility
Program Tracking Project Findings

Keith J. Mueller, Ph.D.
RUPRI Center for Rural Health Policy Analysis

The following activities were either continued or initiated in Year 02 of this project:

1.  Improving and maintaining the project Web site.
2.  Presentations at professional meetings.
3.  Publication of "Findings from the Field."
4.  Publication of special products.
5.  Coordination with the Technical Assistance and Services Center (TASC).
6.  Adding to the Advisory Committee.
7.  Briefing for Congressional staff.
8.  Working with the state offices of rural health and state grantees.

1. Improving and Maintaining the Web Site

The Rural Policy Research Institute (RUPRI) maintains the project Web site: www.rupri.org/ rhfp-track. This name represents a change from the name of the original site, to be consistent with the change to "tracking" instead of "evaluation." 

The following changes were made to improve the Web site:

• The update section on the first page was enriched to include updates in the grid, public lists of Critical Access Hospitals (CAHs), and the map of the location of CAHs. 

• A presentations section was added.

• A hot link to the TASC was added.

Since the site was created in November 1999, and through June 30, 2001, there have been 1,919 "hits." All Tracking Team documents and presentations can be downloaded from the site.

2. Presentations at Professional Meetings

Members of the Tracking Team increased their activities in professional meetings during the second year, including the following:

• Presentation at the North Dakota Conference on Rural and Public Health: "Emergency Medical Services and the Medicare Rural Hospital Flexibility Program." Julie Schoenman. February 27, 2001.

• Participation in the "Flex Hour" teleconference with state grantees on September 27, 2000: Amy Hagopian, John Gale, and Stephanie Poley.

• "CAH Strategies for Community Development and Rural Health Infrastructure Enhancement." John Gale. National Rural Health Association Annual Meeting. May 23, 2001.

• "CAH Conversion, Network Linkages and the Implementation of Quality Improvement Initiatives." Walter Gregg. National Rural Health Association Annual Meeting. May 23, 2001.

• "The Financial Condition of Critical Access Hospitals, Pre- and Post-Conversion: 1995-2000." Andrew Cameron. National Rural Health Association Annual Meeting. May 23, 2001.

• "Update on the EMS Initiatives under the Medicare Flexibility Program." Julie Schoenman, Penny Mohr and Curt Mueller. National Rural Health Association Annual Meeting. May 23, 2001.

• "Reasons Why Small Rural Hospitals may not Convert to Critical Access Hospital Status." Peter House. University of Washington. National Rural Health Association Annual Meeting. May 23, 2001.

• "Flex and Beyond," a discussion with the audience about the future of the Rural Hospital Flexibility Program. Keith Mueller, Dick Morrissey and Jerry Coopey. National Rural Health Association Annual Meeting. May 25, 2001.

• "Community Development." John Gale. Technical Assistance and Services Center's National Flex/CAH Conferences. Seattle and Cincinnati. June 2001.

• "Tracking Team's Second Year Report." Technical Assistance and Services Center's National Flex/CAH Conferences. Seattle (Amy Hagopian) and Cincinnati (John Gale). June 2001.

• "Rural Hospital Flexibility Program and What it Means for the States." Gary Hart. National Conference of State Legislators. Boise, Idaho. June 2001.

3. Publication of "Findings from the Field"

As of June 15, 2001, 15 "Findings from the Field" have been published and disseminated. All 15 are posted on the Web site and in Appendix E. Hard copies of these documents are distributed directly to state offices of rural health, state recipients of the Flex Program grant (if different from the state office of rural health), state hospital associations, and hospitals visited as part of the Tracking Project. In addition, an email announcement is distributed to policy makers (staff in Congress in particular) and to critical access hospitals for which email addresses are obtainable. Consideration is being given to fax distribution of announcements of publications that are available. Copies are made available at regional and national meetings, including: The National Rural Health Association meeting, regional meetings of state offices of rural health, the Association for Health Services Research, TASC regional meetings, and some state rural health association meetings.

4. Publication of Special Products

The first annual report is available on the Web site. A special monograph summarizing first year findings was published and distributed widely to states, hospitals, and others. The monograph was distributed at the same meetings as the Findings from the Field and was distributed at a special briefing on Capitol Hill. The Federal Office of Rural Health Policy has distributed the monograph at various meetings. A short article was accepted for publication in the Journal of Rural Health and is expected to appear in Vol. 17, either the spring or summer issue. 

5. Coordination with the Technical Assistance and Services Center (TASC)

In addition to mutual "hot links" on the two Web sites, staff from TASC attend Tracking Team meetings, and the Director of the RUPRI Center attends TASC advisory committee meetings. TASC was included in the briefing for Congressional staff in May. 

6. Adding to the Advisory Committee

The Advisory Committee to the Tracking Project was expanded to include an administrator from a critical access hospital in Illinois, Hervey Davis. Existing members included Kris Sparks (Washington's Office of Rural Health), Dave Palm (Nebraska's Office of Rural Health), and Brad Gibbens (University of North Dakota's School of Medicine). This committee provides a member to sit in on Tracking Team conference calls and attend all meetings.

7. Briefing for Congressional Staff

A briefing session, "The State Rural Hospital Flexibility Grant Program and Critical Access Hospitals," was held at the Capitol in Washington, D.C., on May 14, 2001. More than 30 staff from various offices attended (a list of the offices is provided as an attachment). Attendees included staff from the offices of the co-chairs of the House Rural Health Coalition and the Senate Rural Health Caucus. The briefing included presentations by Keith Mueller for the Tracking Team, Terry Hill for TASC, and Forrest Calico for the Federal Office of Rural Health Policy. Julie Schoenman and Curt Mueller (Project HOPE) and Stephanie Poley (UNC) also attended to respond to audience questions. Keith Mueller provided information about the number of hospitals certified as Critical Access Hospitals, the number contemplating conversion, and the number that considered conversion but decided not to do so. He also presented findings from the first and second years of the Tracking Project. Terry Hill focused on specific legislative and administrative issues that have been communicated to TASC. Forrest Calico discussed the potential future direction of the Flex Program. The integrated presentation of all three is available on the Tracking Project Web site. Much of the dialogue during the briefing focused on these major points:

The Flex Program is broader in scope than the process of designating and certifying critical access hospitals. The Flex Program also includes state efforts to improve emergency medical services and promote the development of rural health care delivery networks, and hospital efforts to implement systems of continuous quality improvement.

The Flex Program is moving into a "second generation." In many states, most, if not all, of the hospitals eligible to convert have done so. In those states, attention of the Flex Program is shifting to a greater emphasis on emergency services and quality improvement.

8. Working with State Offices of Rural Health and State Grantees

Members of the Tracking Team have provided assistance to state evaluation teams in Minnesota, Nebraska, North Carolina, and Washington. Specific questions concerning evaluation are routed through TASC or the Web site directly to the appropriate research center given the specifics of the request. For example, emergency medical service assessment questions are routed to the Walsh Center at Project HOPE. 

Members of the Tracking Team attended various regional state office of rural health meetings during the year, sometimes speaking on related topics and being available as a general resource about the Flex Program. For example, Project HOPE's Walsh Center has attended regional meetings as part of a related project on state uses of health services research, and RUPRI has been to regional meetings to speak about the Benefits Improvement and Protection Act of 2000. 

The Tracking Team has been involved in dialogues with state office representatives in other forums to think about the future of the Flex Program. For example, a session at the Annual Meeting of the National Association of Rural Health was devoted to this purpose, and time was set aside at the two national TASC meetings on the Flex Program for this purpose. The Tracking Team continues to participate in the dialogue about the context and content for reauthorization of the Flex Program.

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