Appendix D6: Follow-up Interview Questions for Year One Informants

Rural Hospital Flexibility Program Tracking Project

Appendix D6
Follow-up Interview Questions for Year One Informants

State Level Follow Up Questions

1. At the time of our visit, the state proposed to conduct the following initiatives: (detail) What is the status of these initiatives? Have you been satisfied with the outcome(s)? If you had it to do over again, what would you do differently?

Meshing the RHFP with other state initiatives targeting access, quality and cost effectiveness of care for Medicaid and low income, uninsured patients through community health networks
Expanding planning and implementation support for CAH networks to facilitate further integration (i.e., beyond spoke-and-hub).
Finding ways to further emphasize the importance of focusing on the patient and not the provider in program activities and support

2. What are the state's goals/plans for Year 2 of the RHF Program? How do these goals/plans differ from Year 1. Why do they differ? Where these changes integrated into the second year grant proposal? How?

Supporting the development of organizational structures to not only meet current needs but contain sufficient flexibility to adjust to future issues.
Strategies for maintaining financial stability in the face of managed care and increased competition.
Identifying and meeting the needs of the state's marginal populations.

3. Is the state providing on-going support to CAHs after conversion? If so, what kind of support?

4. What is the status of converted hospitals? How many hospitals have converted to date? Are there any additional hospitals in the pipeline? Have there been any notable successes? Any notable failures? How are the converted hospitals fairing in general?

5. Are the hospitals that are considering conversion in Year 2 different in any way than the hospitals that converted in Year 1? If so, in what ways?

6. What do the non-converting hospitals look like? What efforts are non-converters undertaking to remain viable? Is the state providing any support to non-converting hospitals? e non-converters by asking about those that didn't convert verses those that either started the process (e.g., filed application with the state, or otherwise engaged in obvious activities to evaluate and decide about conversion) or later elected not to convert? What do you think separates these "non-converters" from the ones that become CAHs? Are they pursuing any other strategies to remain viable? Is the state involved in any way with them?

7. (Review relevant findings from the field with key respondent.) Are the key points (or initiatives) described in this finding from the field still accurate? If not, what has changed? What is the state doing differently?

8. What are the state's long term goals/plans for the RHF Program?

9. Is the state doing anything to support the development of the health care infrastructure at the community level? If yes, please describe these efforts.

10. Is the state actively encouraging the development of rural health networks? If yes, how is it doing so? What types of networks? What types of providers are involved (e.g. hospitals, community providers, physicians practices, etc.)

Hospital Level Follow Up Questions

1. At the time of our visit, the following initiatives/activities were underway at your hospital. (detail) What is the status of these initiatives/activities?

2. Have hospital operations changed since we visited last year [____ Date]?

a) Service Utilization

i) Inpatient volume? (increased/decreased/remained stable?) Why?
ii) Outpatient volume? (increased/decreased/remained stable?) Why?
iii) Home health, ambulance, other services? (increased/decreased/remained stable?) Why?

b) Market Changes

i) Share of market? (increased/decreased/remained stable?) Why?
ii) Provider relationships? (improved/deteriorated/remained stable?) Why?
iii) Community relationships? (improved/deteriorated/remained stable?) Why?
iv) Relationship with its support hospital? (improved/deteriorated/remained stable?) Why?
v) Competition? (Describe changes in competitive market if any)

c) Financial Situation

i) Better/Worse?
ii) How has it changed?
iii) Reason for change?

3. What is the hospital doing differently (if anything) than it was doing a year ago?

4. Your hospital was involved in a number of network or network related activities last year: (review all activities). Did they achieve their intended goals? If not, why not? Would you do it differently in light of the experience gained during the past year? If so, what would you do differently? Any new networking efforts underway or being planned? If so, please describe these new initiatives.

5. Is your hospital receiving ongoing support from the state? If so, what kind of support? What other type of support might be useful that your hospital is currently not receiving from the State? Federal government?

6. Are you receiving any Flex Program grant funds from the current year's Flex Grant? If so, how are they being used?

7. Please evaluate the longer term impact of CAH conversion on your hospital. If you had it to do over again, would you still recommend conversion? Why or why not?

8. Has the conversion of your hospital, or any of these reported changes since last year's visit provided opportunities to further improve the financial and/or market position of your hospital that otherwise would not have been available or possible?

9. What are the hospital's long term strategic goals/plans?

10. Have you developed any new initiatives in the following areas: (Please describe)

a) EMS services?
b) Quality assurance/quality improvement?
c) Networking?

i) Support hospital
ii) Hospital/health care system
iii) Local/community providers

d) Scope of services changes?

(i) Long term care
(ii) OB/GYN
(iii) Surgery
(iv) Mental health
(v) Other services

e) Market share improvement?
f) Development of the community health care infrastructure/addressing community level needs?
g) Administrative quality?

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Last modified: 05/07/08