1. Small Rural Hospital improvementprogram (SHIP)FY’11 Overview webinarMarch 4, 2011 Melissa Kleffner-Wansing, MSW SHIP Coordinator, Office of Primary Care and Rural Health 1

2. SHIP Overview 1. Program Purpose/ Use of Funds 2. Hospital Eligibility 3. Funding Availability 4. Revised SHIP Process from Beginning to End 5. Vendor Request for Payment/Invoicing 6. New Categories 7. Changes for FY’11 SHIP Process 8. FY’10 Summary Report 9. FY’10 Contract Amendment 2

3. SHIP Program Purpose/Use of Funds The Small Rural Hospital Improvement Program (SHIP) is funded by a grant from the Health Resources and Services Administration (HRSA), Office of Rural Health Policy (ORHP). SHIP funding allows small rural hospitals in Missouri to improve health care services to their communities. SHIP funds are available to purchase computer hardware/software, training/education and consultant services/assessments in any or all of the funding categories: Prospective Payment Systems (PPS) Accountable Care Organizations (ACO) Payment Bundling Value-Based Purchasing (VBP) 3

4. SHIP Hospital Eligibility To access funding from this grant, a hospital must have 49 staffed beds or less as reported on the hospital’s most recently filed Medicare Cost Report and be located outside a Metropolitan Statistical Area (urban area). All designated Critical Access Hospitals are eligible. 4

5. Funding Availability FY’11 Grant Period: September 1, 2011-August 31, 2012 Approximate amount for each hospital: $9,000.00 5

6. Revised SHIP Process from Beginning to End For a typical grant period, we’ll use FY’11 as the example- September 1, 2011-August 31, 2012 Application released around February 2011- hospitals who want to apply complete and return to State Office of Rural Health (SORH) by March 17, 2011 deadline. After several months, the Department of Health and Senior Services (DHSS) Procurement Office will mail the participating hospitals a Contract which will include the grant amount for that year. It is critical that all participating hospitals review, sign and return the contract to DHSS Procurement Office in a timely manner. 6

7. Revised SHIP Process from Beginning to End (Cont’d) Once DHSS Procurement Office obtains all signed contracts, they will have the DHSS Division of Administration (DA) sign them and return to the hospitals. Once the contract is signed by DA, the contract is considered to be “Executed.” This also means the contract is in effect! Now it is time for Invoicing- use the state required Vendor Request for Payment (VRP) form to request reimbursement. 7

8. Vendor Request for Payment/Invoicing Invoicing Per the SHIP contract, the hospital will be paid on a one-time basis upon receipt and approval of a properly prepared invoice and receipt of the reporting forms. The final invoice is due within thirty (30) calendar days of the contract ending date. Purchases can only be made during the contract period. The VRP and invoices shall be mailed to: Missouri Department of Health and Senior Services Office of Primary Care and Rural Health P.O. Box 570 Jefferson City, MO 65102-0570 The VRP and invoices can also be faxed to 573-522-8146 or scanned and e-mailed to Melissa.Kleffner-Wansing@dhss.mo.gov 8

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10. Vendor Request for Payment/Invoicing (cont’d) Fictional Example: Current FY’10 Contract Period runs from September 1, 2010-August 31, 2011. Each hospital was awarded $8,500 St. Olaf’s Mercy Hospital is participating in SHIP FY’10 St. Olaf’s Mercy Hospital applied for their SHIP funds to purchase Lean Six Sigma performance software and then also for training staff to use this new performance software. These purchases would fall within the category of Value-Based Purchasing (VBP). On November 15, 2010, the software was purchased for $7,000.00 On February 10, 2011, staff were trained to use this new software. The cost was $2,000.00 No additional purchases will be made for SHIP funding during this contract period. The billing period would be November 15, 2010- February 10, 2011 because the invoice for the software was dated November 15, 2010 and the invoice for training staff was dated February 10, 2011. The date in which the VRP is signed can only be dated either February 10, 2011 as that is the last day of the billing period or whenever the VRP and invoices are submitted to DHSS before September 30, 2011 as that is the deadline to submit invoices/VRP (30 days after the contract period ends). The date cannot be any day before February 10, 2011. 10

11. SHIP One St. Olaf’s Mercy Hospital 123 Shady Pines St. Olaf, MO 65432 5555555555 5 November 15, 2010- February 10, 2011 Small Rural Hospital Improvement Program C555555555 $8,500.00 Sophia Patrillo Vice President of Operations 3-2-11 11

12. New Categories For FY’11, hospitals will continue to use SHIP funds to support activities in the following categories: Implementation of Prospective Payment Systems (PPS) Staff training for transition to ICD-10 (recommended by ORHP). See CMS ICD-10 webpage for overview at http://www.cms.gov/ICD10/. Implement/update chargemaster systems Training in billing and coding Value-Based Purchasing (VBP) Accountable Care Organizations (ACO) Payment Bundling 12

13. New Categories (cont’d) Value Based Purchasing (VBP)- improving data collection activities in order to facilitate reporting to hospital compare. Staff training in Hospital Compare Staff training and education on streamlining data collection Purchase software for patient care tracking Purchase a Lean Six Sigma performance software Updating revenue cycle management procedures Purchase management and patient safety program to evaluate and track medication errors, adverse drug reactions, drug usage, drug purchasing, drug storage/inventory, and drug distribution Update ECG machines to transfer images to network hospitals for cardiology interpretation Purchase subscription to Joint Commission Quality Measures Staff education to improve surgical care 13

14. New Categories (cont’d) Accountable Care Organizations (ACO)- The ACO concept is heavily focused on improving quality outcomes. Any activities that support quality improvement such as reduction of medical errors as well as education and training in data collection, reporting and benchmarking. Staff-wide cultural competency training to improve health outcomes Assessment, data analysis, training on avoidable re-hospitalizations Purchase of wireless technology to reduce medical errors Participate in a national benchmarking system to improve patient outcomes Purchase software for reporting tools to reconcile and track medication error reduction Purchase hardware/software to connect EKG results directly into patient’s EMR for physician review Purchase services to survey patient satisfaction Training in safe patient handling to decrease patient falls Staff QI training Purchase defibrillators to ensure quality in treating heart attack victims Purchase hardware to track discharge instructions from providers 14

15. New Categories (cont’d) Payment Bundling- One of the concepts behind bundled payment is building accountability across the continuum of care. This could be done in the form of training, clinical care transition protocol development or data collection that documents these processes. Extension of wireless network to physicians’ offices to improve accountability across continuum of care Staff education on palliative care transition Staff training on improving care transitions and case management services 15

16. Changes for FY’11 SHIP Process New Requirements PPShospitals applying for SHIPfunding must submit a photocopy of Worksheet S-3from the most recently filed Medicare Cost Report to certify their staffed bed count. This document must be submitted electronically along with the FY’11 SHIP Application by March 17, 2011. Hospitals will no longer be required to complete an end-of-year SHIP Progress Report. You will now submit a summary report detailing: (1) the progress achieved since submission of the FY’10 SHIP application including activities that have been performed (from September 2010 to March 2011) or will be conducted later in the budget period (from April 2011 to August 31, 2011); (2) Describe current and anticipated challenges to completing FY’10 activities and how they were or will be resolved (if applicable); (3) describe whether you are utilizing FY’10 SHIP funds as an individual hospital or as a network/consortium. Again, this document must be submitted electronically along with the FY’11 SHIP Application due to SORH by March 17, 2011. 16

17. SHIP FY’10 Summary Report (To be returned along with SHIP FY’11 Application to SORH by March 17th, 2011) Hospital Name: Hospital Address: Hospital Contact, phone number and E-mail: Hospital Activities: 1. Explain the progress achieved since submission of the FY’10 SHIP Application- Indicate if proposed activities have (a) been performed or (b) will be conducted later in the budget period (from May 1, 2011-August 31, 2011). (a): (b): 2. Describe currentandanticipated challenges to completing FY’10 activities and how they were (or will be) resolved, if applicable. 17

18. SHIP FY’10 Summary Report (cont’d) Network/Consortium Activities: Explain the progress achieved since submission of the FY’10 SHIP Application- Indicate if proposed network/consortium activities have (a) been performed or (b) will be conducted later in the budget period (from May 1, 2011-August 31, 2011). (a): (b): 2. Describe currentandanticipated challenges to completing FY’10 activities and how they were (or will be) resolved, if applicable. 3. If you are receiving FY’10 SHIP funds as a network/consortium, indicate if the network/consortium is: (please underline one) a SHIP network/consortium (a Network formed solely for the purposes of SHIP) Or (b) Other network (a network formed for purposes other than SHIP that offers programs/services that SHIP hospitals can “buy into” with SHIP funds. Previously referred to as existing networks. 18

19. FY’10 Contract Amendment The total amount awarded for each hospital in FY’10 was $8,281.30; however, one hospital chose to decline participation during the contract process. The amount for that hospital will now be divided with the remaining 39 hospitals. A contract amendment will be mailed to each hospital soon in the amount of $212.34. New FY’10 Awarded Amount= $8,493.64 19

20. To participate in FY’11 SHIP Funds, submit electronically by Thursday, March 17, 2011: 1. FY’11 SHIP Application 2. Photocopy of Worksheet S-3 if applying for PPS funding 3. FY’10 SHIP Summary Report (if your hospital participated in FY’10 SHIP funding). To: Melissa Kleffner-Wansing, MSW Office of Primary Care and Rural Health Melissa.Kleffner-Wansing@dhss.mo.gov 573-526-2825 or toll free (800) 891-7415 In Summary… 20

21. Melissa Kleffner-Wansing, MSW Office of Primary Care and Rural Health Center for Health Equity P.O. Box 570 Jefferson City, MO 65102-0570 Melissa.Kleffner-Wansing@dhss.mo.gov 573-526-2825 Toll Free (800) 891-7415 Contact Information 21