State Rural Hospital Flexibility Program

The Kentucky Rural Hospital Flexibility Program (KRHFP/Flex) is under the auspice of the Kentucky State Office of Rural Health (KSORH), which is housed within the University of Kentucky Center for Rural Health (UKCRH). The KRHFP partners include, Kentucky Hospital Association, Kentucky Department of Public Health, Kentucky Primary Care Association, and Kentucky Area Health Education Centers, Kentucky Board of EMS, University Medical Placement Service's, Eastern and Western Kentucky Universities, UK College of Agriculture and Cooperative Extension Service and Kentucky TeleCare. Through these partnerships, the strategy is to build rural systems of care by strengthening Critical Access Hospitals and eligible facilities which enable them to serve as the hub of a collaborative delivery system in their communities. The Flex staff has developed and implemented sustainable programs, which includes the CAH conversion program, mock survey program, educational and training program, network development program, technical assistance program and evaluation program. Through the Conversion Program, twenty four rural hospitals have converted to critical access certification in a simplified and expedited manner. Eleven additional rural hospitals have completed financial feasibilities studies to determine if conversion to Critical Access will improve the financial performance of their hospital and meet the needs of their communities. One hospital is currently involved in the conversion process. The staff continues to support the development of partnerships among rural hospitals, local providers, community organizations and rural health networks to address strategic planning, access to capital; community based health care leadership, and disease management programs. The Flex staff continues to facilitate, inform, educate and assist communities, hospitals and providers on the importance and benefits of networking. The flex staff has provided technical assistance to six formalized networks in various stages of development which will require ongoing support for long-term sustainability. Through these networks work has begun on new projects such as joint purchasing, infection control activities, a shared continuing education/in-service calendar, joint recruitment efforts and joint marketing campaigns. Two of these networks were among eleven that received federal HRSA outreach grants aimed at fostering greater coordination of services and partnerships in the delivery of care to rural areas. The Flex staff collaborates with the Kentucky Board of Emergency Medical Services (EMS) and local EMS to promote the strengthening and integration of rural Emergency Medical Services as a critical component of rural health networks and their communities. Through partnerships with university programs, the Kentucky Flex Program funds first responders, emergency medical technicians, and paramedic training courses and provides continuing educational programs for EMS professionals to assist rural communities with workforce shortages. The partnership between the KRHFP and the Kentucky Hospital Association allows the Critical Access Hospitals, rural health networks and other rural hospitals to identify and take advantage of potential funding opportunities. The Kentucky Hospital Association's Rural Hospital Clinical Benchmarking Program provides comparative state data to Critical Access Hospitals and other rural hospitals, which was not previously available. Quality specific data allows these hospitals to benchmark and determine best practices. Future plans are to initiate a Quality Improvement Network for CAHs. The Flex staff and the Kentucky Hospital Association staff encourage and support the development of rural hospital performance improvement initiatives that expand and improve management and fiscal capacity. Currently there are two rural hospitals that utilize the Balance Scorecard management strategy and it is the intent of the Flex program to expand this to other hospitals in the coming year. The Kentucky Rural Health Works Program provides the KRHFP with an evaluation process, surveys, financial and economic analysis, and other studies that provide information to rural providers, communities and KRHFP staff. The Kentucky Rural Health Works ongoing evaluation found that Kentucky Critical Access Hospitals are developing a stronger financial position and are in the process of becoming financially stable.