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Small Rural Hospital
Transition (SRHT) Project
Financial and Operational Assessment
_____________Hospital Work Plan
525 South Lake Avenue, Suite 320 │ Duluth, Minnesota 55802
(218) 727-9390 │ [email protected]
Get to know us better: www.ruralcenter.org/rhi
The Small Rural Hospital Transition (SRHT) Project is supported by Contract Number
HHSH250201600012C from the U.S. Department of Health and Human Services, Health
Resources and Services Administration, Federal Office of Rural Health Policy
RURAL HEALTH INNOVATIONS 2
TABLE OF CONTENTS
Small Rural Hospital Transition (SRHT) Project .................................................. 3
Financial Operational Assessment (FOA) Project Objectives .............................. 3
_____________Hospital Work Plan .................................................................. 4
Hospital Readiness for A SRHT Project .............................................................. 5
Who Should Be Involved in the Project? ............................................................ 6
Executive Leadership ................................................................................... 6
Management Team ...................................................................................... 6
SRHT Consultation Method .............................................................................. 7
First Onsite Consultation Visit: Interviews ...................................................... 7
Second Onsite Consultation Visit: Report Presentation and Action Planning ........ 7
Contact Information ....................................................................................... 8
SRHT Project Contact Information ................................................................. 8
Consultant Contact Information .................................................................... 8
Appendices.................................................................................................... 9
Appendix A: FOA Interview schedule and First Onsite Consultation Agenda ...... 10
___________ Hospital Interview Schedule ................................................ 10
Appendix B: FOA Data Request ................................................................... 11
Appendix C: FOA Anticipated Outcomes and Tracking Measures ...................... 12
Appendix D: HCAHPS Survey Questions for FOA SRHT Tracking Measures ........ 13
Appendix E: Recommendation Adoption Progress (RAP) Interview Questions .... 14
RURAL HEALTH INNOVATIONS 3
SMALL RURAL HOSPITAL TRANSITION (SRHT) PROJECT
The Small Rural Hospital Transition (SRHT) Project was created by the Federal
Office of Rural Health Policy to assist rural communities and their hospitals in
successfully navigating the changing health care environment. The SRHT Project
supports small rural hospitals nationally by providing on-site technical assistance
(TA) to help them bridge the gaps between the current fee-for-service system and
the newly emerging one based on quality and value. The SRHT Project supports
nine (9) selected small, rural hospitals with onsite TA in the core areas of financial
and operational assessments (FOA) and quality improvement (QI) projects. At least
three (3) hospitals are selected for each core area of FOA and QI projects.
The SRHT Project is designed to transition rural hospitals to value-based care and
payment models, as well as prepare them for population health management. While
the technical assistance helps leaders with improving their hospitals’ financial and
quality performance, the primary focus is to support them in preparing their
facilities for participation in value-based care models and payment systems (such
as patient-centered medical homes and hospital shared savings program) that
position their hospitals for the future.
Financial Operational Assessment (FOA) Project Objectives
The financial operational assessment (FOA) assesses the hospital’s operations at
the department level to establish planning priorities and develop action steps to
implement best practices that improve efficiency. The objective is to financially
position the hospital for the future. The FOA evaluates opportunities for:
Physician alignment and service area provider complement to support
primary care
Primary care recruitment strategies and review provider incentive
compensation
Alignment of services with community needs
The consultation methodology supports the objectives by assessing the following
key areas:
Historic/potential demand for clinical services
Clinical service line gaps
Reimbursement and cash flow with emphasis on selected service lines
Physician practice management
Hospital expense analysis
Hospital’s organizational architecture and management principles
_____________HOSPITAL WORK PLAN
Hospital Activity Deadline
Complete pre-project planning activities
Perform an online transition planning self-assessment prior to planning calls
Hold project planning call with the consultant and SRHT Project staff at 5 - 6 weeks
prior to first onsite consultation. Call hosted by SRHT Project staff.
Submit data request to consultant at [email protected].
Submit interview schedule to Bethany Adams at [email protected]. Interview
schedule is the agenda for the first onsite consultation.
Hold a second project planning call with the consultant one week prior to the first
consultation date. Call hosted by consultant
First onsite consultation – one (1) day onsite at hospital
Hold interviews with executive and management teams following the interview
schedule
Refer to who should participate
Hold exit interview with CEO
Review report
CEO to submit feedback on report to the consultant to prepare for the second onsite
visit. A call may be held with the consultant, if needed, to review the report and
recommendations. CEO should schedule this call directly with the consultant.
Second onsite consultation – One (1) day onsite at hospital
Present report and recommendations to executive and management teams, key
staff, medical staff and board members through one meeting
Develop action plan with executive and management team members to implement
best practice recommendations to improve processes and maximize performance
Develop strategies with executive team that prepare the hospital for transitioning to
a value-based system
Refer to who should participate
Finalize report and action plan
Report is considered final after two weeks following the consultation
Complete post-project activities
Monitor progress using SRHT tracking measures for 12 months
Hold first Recommendation Adoption Progress (RAP) interview at 5 months post-
project. Rhonda Barcus will coordinate the call
Submit post-project values at 12 months to [email protected] prior to RAP
call
Hold second (final) RAP interview at 12 months post-project
Retake an online transition planning self-assessment at 12 months
TBA by
Rhonda
Barcus
HOSPITAL READINESS FOR A SRHT PROJECT
Consultation services are provided to selected hospitals that are deemed ready,
willing and able to undertake a comprehensive project. Selected hospitals must be
willing and able to meet program requirements and project expectations. Selected
hospitals must be prepared to:
Initiate and complete project within the defined timeline of their work plans
Perform a transition planning self-assessment prior to and following the
consultation at 12 months post-project
Schedule and reserve onsite consultation dates (projects may not be
rescheduled nor rolled over to the next fiscal year)
Meet deadlines and respond in a timely manner
Submit data requests by deadlines (refer to Appendix B for more information
about the FOA Data Request)
Submit interview schedule for first onsite visit by deadlines (refer to
Appendix A for the FOA Interview Schedule)
Track SRHT Project measures and report pre-/post values (refer to Appendix
C for FOA Anticipated Outcomes)
Provide pre-/post values for SRHT tracking measures
Prepare the board, management team and any other team champions for the
onsite consultations
Utilize resources available through the Transition Toolkit to support the
implementation of best practices and transition process
Implement consultant recommended best practices and transition strategies
Demonstrate measurable outcomes and show impact from the project
activities
Complete a Recommendation Adoption Progress (RAP) interview at 5 and 12
months post-project (refer to Appendix E for RAP Interview Questions)
Share successful strategies and project outcomes with other rural hospitals
through PMG calls, Hospital Spotlights, and possible state network meetings
Participate in HELP webinars and PMG calls to build staff capacity that
supports the implementation process and sustains post-project gains
Hospitals unable to meet program and readiness requirements, to include
deadlines, will be placed back in queue for future consideration and the
consultation slot will be provided to the next ranked hospital.
RURAL HEALTH INNOVATIONS 6
WHO SHOULD BE INVOLVED IN THE PROJECT?
Executive Leadership
SRHT Projects are large, comprehensive consultations that require top leadership
involvement from the executive team to include the chief executive officer (CEO),
chief financial officer (CFO), chief nursing officer (CNO), chief operating officer
(COO), chief medical officer (CMO) and chief information officer (CIO). The SRHT
Project requires the hospital CEO to be actively involved and engaged in the
consultation. The CEO is expected to facilitate the project planning and onsite
consultations, implement best practices and transition strategies, as well as follow-
up with SRHT staff to complete feedback assessments and RAP interviews. SRHT
will not accept a representative in lieu of the CEO.
Management Team
The hospital’s management team should be actively involved and prepared to
participate in the interviews and action planning. Key departments and leaders to
include the following:
Emergency Dept. Director or Manager
Human Resources Manager
IT Director/Security Officer
Lab Director or Manager
Medical Director/Med Staff
Nursing Home/Home Health/
Ambulance
Physician Practice Director or Manager
Quality Director or Manager
Radiology Director or Manager
Rehabilitation/Therapy
Respiratory Therapy Manager
Revenue Cycle Manager
Surgery Director or Manager
Hospital teams should work collaboratively with the consultant to develop action
steps to implement recommended best practices to improve care management and
transition of care processes, as well as develop strategies to transition to a value-
based system. These champions should be engaged throughout the project to
successfully implement consultant recommended best practices.
RURAL HEALTH INNOVATIONS 7
SRHT CONSULTATION METHOD
First Onsite Consultation Visit: Interviews
The first consultation visit consists of a full day of interviews with executive and
management team members, medical staff and board members. The first
consultation visit focuses on finding opportunities for performance improvement, as
well as discovering strategies that supports the hospital’s transition process.
Additional data may be requested as follow up to consultation. Refer to Appendix A
for the FOA Interview Schedule Template. The interview schedule outlines the
agenda for the first onsite consultation.
Second Onsite Consultation Visit: Report Presentation and Action
Planning
The second onsite visit requires a full day for the executive and management
teams. Executive and management teams should participate in both the report
presentation and action planning sessions. The first half of the day consists of the
report presentation to the executive and management teams, as well as board
members, medical staff and any other key community champions that the CEO
would like to invite. The remaining half of the day is devoted to the action planning
process. The objective is to provide the hospital teams with a clear understanding
of the opportunities and recommendations so that the:
Management teams can develop action plans to implement the best practice
recommendations at the department level; and
Executive team can develop strategies that positions the hospital for the
future and transitions them to a value-based system.
RURAL HEALTH INNOVATIONS 8
CONTACT INFORMATION
SRHT Project Contact Information
Bethany Adams, MHA, FACHE, MT(ASCP)
National Rural Health Resource Center
Rural Health Innovations, LLC
Senior Program Manager 525 S. Lake Avenue, Suite 320 Duluth, MN 55802
Direct: (859) 806-2940 Email: [email protected]
Website: http://www.ruralcenter.org
Rhonda Barcus, MS, LPC
National Rural Health Resource Center
Rural Health Innovations, LLC
Program Specialist 525 S. Lake Avenue, Suite 320 Duluth, MN 55802
Direct (904) 321-7607 Email: [email protected]
Website: http://www.ruralcenter.org
Consultant Contact Information
Lindsay Corcoran, MHA
Stroudwater Associates
Consultant Portland, ME 50 Sewall Street, Suite 102
Portland, ME 04102 (T/F) 207-221-8262
(C) 207-939-7414 Email: [email protected] Website: www.stroudwater.com
Matthew Mendez, MHA
Stroudwater Associates
Senior Consultant Portland, ME 50 Sewall Street, Suite 102
Portland, ME 04102 (C) 910-508-7672
Email: [email protected] Website: www.stroudwater.com
RURAL HEALTH INNOVATIONS 9
APPENDICES
RURAL HEALTH INNOVATIONS 10
Appendix A: FOA Interview schedule and First Onsite Consultation
Agenda
___________ Hospital Interview Schedule
Onsite Date:
Enter names to complete interview schedule and submit to [email protected].
Time Executive
Interviews Interviewee Name(s)
8:30 - 9:00 Facility Tour
9:00 - 10:00 CEO
10:00 - 11:00 Finance / CFO
11:00 - 12:00 Nursing / CNO
12:00 - 1:15 Combined Board, Medical Staff, and Executive Team Meeting / Lunch Presentation
Time Track 1
Dept. Interviews
Interviewee
Name(s)
Track 2
Dept. Interviews
Interviewee
Name(s)
1:15 - 1:45 Rehabilitation /
Therapy
Quality /
Director or Manager
1:45 - 2:15 Revenue Cycle
Manager
Laboratory /
Director or Manager
2:15 – 2:45 Respiratory Therapy /
Manager
Surgery /
Director or Manager
2:45 – 3:15 Medicine / CMO Radiology /
Director or Manager
3:15 – 3:45 Physicians Practice /
Director or Manager
Emergency Dept. /
Director or Manager
3:45 – 4:15 IT Directory / Security
Officer
Human Resources
Manager
4:15 – 5:00 Medical Director /
Medical Staff
Nursing Home / Home
Health / Ambulance
5:00 Adjournment
Exit Interview with CEO will be scheduled via teleconference
RURAL HEALTH INNOVATIONS 11
Appendix B: FOA Data Request
The FOA data request is an excel file workbook, which will be forwarded to
you via email. The CEO should submit the SRHT data request in electronic format
directly to Stroudwater Associates Consultant, Lindsay Corcoran, at
One designee is acceptable for submitting the hospital’s data request. The CEO
may not elect more than one representative to submit data nor designate any
other person to lead the project. SRHT Project requires the CEO to serve as the
project lead (refer to program requirements).
The data request must be completed by the SRHT defined deadline for your
hospital. SRHT Project requires data to be submitted in full by the deadline (refer to
hospital readiness). Questions regarding deadlines and/or the submission
requirements should be forwarded to Bethany Adams at [email protected].
Technical questions about the data should be forwarded to Lindsay Corcoran at
The CEO (and the designee if chosen by the CEO) is/are responsible for tracking the
submission to ensure the quality and accuracy of the data. The designee must cc
the CEO on all data submissions when forwarding information to the
consultant.
Please do not leave blanks by providing a justification for missing
information and explaining why data is not tracked. If the data is unavailable,
then provide an explanation to clarify why the information is unobtainable or
inaccessible. If the data is not tracked by the hospital, please clarify why the
information is not monitored nor trended.
Lastly, do not provide personal information such as patient names or medical record
numbers. Please review the data request prior to submission to ensure that
personal information is not included in the table and files.
RURAL HEALTH INNOVATIONS 12
Appendix C: FOA Anticipated Outcomes and Tracking Measures
Hospitals should track the below measures and report post-project values during the 12 month post-project RAP interview.
Pre-values are captured from the report and during the consultations.
Anticipated Outcome
Tracking Measure
Standard Hospital
Goal Pre-Project
Values Post-Project
Values
Increase total margin by 10% points on an annualized basis
Net Income Not applicable $___ $ ___ $ ___
Increase net patient revenue by 2.5% on an annualized basis
Net Patient Revenue Not applicable $___ $ ___ $ ___
Increase Days of Cash and Investments on Hand by 10
days
Days Cash on Hand US Median for Rural Hospitals
___ days ___ days ___ days
Improve quality of care by improving HCAHPS scores for questions on overall rating of the hospital. Refer
to Appendix D for more
information.
HCAHPS score for overall rating of the hospitals as reported in Hospital Compare or similar
reporting site for items:
“Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)”
“Patients who reported
YES, they would definitely recommend the hospital”
State: _ (%)
National: _ (%) ___ (%) ___ (%) ___ (%)
State: _ (%)
National: _ (%)
___ (%) ___ (%) ___ (%)
RURAL HEALTH INNOVATIONS 13
Appendix D: HCAHPS Survey Questions for FOA SRHT Tracking
Measures
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
Survey Questions1
Would Recommend Your Hospital Composite
Reported in Hospital Compare as:
“Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to
10 (highest)”
“Patients who reported YES, they would definitely recommend the hospital”
HCAHPS Question 21: Using any number from 0 to 10, where 0 is the worst
hospital possible and 10 is the best hospital possible, what number would you use
to rate this hospital during your stay?
HCAHPS Question 22: Would you recommend this hospital to your friends and
family?
1 CMS HCAHPS Survey Questions and Instructions
RURAL HEALTH INNOVATIONS 14
Appendix E: Recommendation Adoption Progress (RAP) Interview
Questions
RAP interviews are conducted at five (5) and twelve (12) months post-project. The
purpose is to assess the extent your hospital adopted consultant recommendations
over time and determine the overall impact of the project.
Tracking measures are reported at twelve (12) months post-project prior to the
final RAP interview. Submit your hospital’s outcome worksheet with tracking
measures to Rhonda Barcus at [email protected] one (1) week prior to the
scheduled call.
1. On a scale of 1 – 5, rate the extent to which the hospital has implemented
consultant best practice recommendations.
• One (1) means that none or few consultant recommendations have
been implemented
• Five (5) represents all recommendations are implemented, and the
project is completed and sustained with measurable outcomes
2. What is your hospital’s current status with regard to implementing the
performance improvement recommendations made by your consultant?
Specifically, what is going well?
3. What are your expected next steps towards adopting your consultant’s
recommendations?
4. Aside from the measurable outcomes, what are some of the ways this project
has impacted your hospital, its culture and the community?
5. How do you believe this project has helped you move forward in the newly
emerging system of health care delivery and payment?
6. What additional resources or training will you need to continue to move
towards the new health care environment and become a participant in a
health care system that focuses on value, such as an Alternative Payment
Model (APM), shared savings program or patient-centered medical home
(PCMH)?
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