State Approaches to Certification of Critical Access Hospitals as “Necessary Providers”

February 4th, 2015

The Flex Monitoring Team has re-issued a 2002 report which aggregates and summarizes the Necessary Provider criteria for each state participating in the Flex Program.



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When A Hospital Closes (Kaiser Health News)

September 25th, 2014

KHN“In a scenario playing out in rural areas across the country, the July 1 closing of Vidant Pungo Hospital in Belhaven NC has left local doctors wondering how they will make sure patients get timely care, given the long distances to other hospitals, and residents worrying about what to do in an emergency and where to get lab tests and physical therapy.”

“This is a big deal, it’s going to put the town out of business,” Bonner said. “We lost all the employees, the income, and now people have to figure out what they’re going to do with medical care.”

Read the full story on Kaiser Health News

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Patients Fall Through Cracks as Hospitals Cut Back on Charity Care

September 22nd, 2014

Link to Kansas City Star article
“Hospitals are really struggling with prioritizing who should get financial aid and what it should be. How do they help the people who need help the most without discouraging people from getting insurance?” said Melinda Hatton, general counsel of the American Hospital Association. It is not clear yet how many hospitals already have made their financial assistance policies stricter, but examples have been cropping up across the country.

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State CAH Hospital Compare Reports Posted

September 10th, 2014

All 45 state-level reports examining Critical Access Hospitals’ performance and reporting rates on Hospital Compare measures, originally distributed to Flex Coordinators and State Offices of  Rural Health in June 2014, are now available for download on  These reports utilize Hospital Compare data from April 2012 through March 2013.
Access your state’s report here.


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Collaborative Community Health Needs Assessment Study Findings Released

May 19th, 2014

The Flex Monitoring Team has released findings from a study examining the feasibility of conducting collaborative Community Health Needs Assessments (CHNAs) in Critical Access Hospitals (CAHs).  The primary purpose of this brief is to inform the efforts of state Flex Programs to support CAHs in conducting collaborative Community Health Needs Assessments (CHNAs). The results of these assessments can be used by hospitals as well as state Flex Programs to inform their ongoing strategic initiatives.

View key findings and download the full policy brief (.pdf) here.

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Rural Community Paramedicine Study Findings Released

March 3rd, 2014

The Flex Monitoring Team has released findings from their study of rural community paramedicine.  A policy brief and full-length report examine the evidence base for community paramedicine in rural communities, the role of community paramedics in the rural healthcare delivery system, challenges faced by states in implementing community paramedicine programs, and the role of the state Flex programs in supporting development of community paramedicine programs, while also providing a snapshot of community paramedicine programs currently being developed and/or implemented in rural ares.  

Researchers found that many rural community paramedicine programs are in pilot stages.  Most community paramedics in rural areas work within an expanded role rather than an expanded scope of practice, as the latter requires legislative or regulatory changes.  Funding and reimbursement are major challenges for these programs; therefore, it is vital that data be collected to demonstrate their value to policymakers.

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OIG 2014 Workplan Includes CAH and RHC Studies

February 13th, 2014

The Rural Assistance Center reports that the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has released its Fiscal Year 2014 Workplan which outlines the activities and reviews that it plans to undertake during the year, including activities that are currently underway. The OIG works to study and protect the integrity of HHS programs. Selected activities from the Workplan include:

  • Critical Access Hospitals – Payment policy for swing bed services: This study is currently underway and will compare reimbursement of swing-bed services in CAHs to similar care provided through traditional skilled nursing facilities to determine if there are Medicare cost savings that could be achieved by changing reimbursement.
  • Critical Access Hospitals – Beneficiary costs for outpatient services: This study is currently underway and will determine the costs that are paid by Medicare beneficiaries when receiving outpatient care at CAHs.
  • Rural Health Clinics – Compliance with location requirements: This report is expected to be released during the FY2014 fiscal year and will look at the extent to which RHCs are in operation that do not meet the basic location requirements for the RHC program. It will also look at the amount of Medicare reimbursement that goes to such clinics.


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Rural Care Coordination Toolkit Launched

February 6th, 2014

The Rural Assistance Center (RAC) and NORC Walsh Center for Rural Health Analysis are announcing a new Rural Care Coordination Toolkit to help rural communities and organizations identify and implement a care coordination program. This toolkit contains resources to help communities develop programs that can improve quality and continuity of care, as well as patient outcomes, building on best practices of successful care coordination program models. The toolkit is available for free on the RAC website.

“Care coordination empowers patients to take care of their health which often results in better health outcomes.  For example, patients in care coordination programs often take a pro-active role in seeking timely health care and are less likely to seek care in emergency departments,” commented Alana Knudson, Co-Director of the NORC Walsh Center for Rural Health Analysis. “Many care coordination programs have also been instrumental in helping elderly patients live independently in their rural communities. The Care Coordination toolkit is a great resource for rural health care providers who would like to implement a program that addresses their patients’ unique needs.”

The toolkit is made up of several modules. Each concentrates on different aspects of developing and implementing care coordination programs. Modules also include resources to use in developing a program.

Content for the Rural Care Coordination Toolkit was developed by the NORC Walsh Center for Rural Health Analysis as part of the Rural Community Health Gateway. The Gateway, located on the RAC website, is designed to help rural communities learn about proven methods of providing rural residents with better access to health care services. Development of these resources is part of an ongoing effort by NORC and RAC to provide evidence-based health information to rural America.

Funding for this project is provided by the federal Office of Rural Health Policy, part of the Health Resources and Services Administration.

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Flex Monitoring Team Launches New Website, Communications Services

January 27th, 2014

The Flex Monitoring Team has launched a new website at, offering quick and easy access to their entire collection of resources aimed at improving the accessibility, viability, and quality of health care for rural residents and communities.   

A consortium of the Rural Health Research Centers at the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine, the Flex Monitoring Team is a performance monitoring resource for Critical Access Hospitals, states, and rural communities.  Their three main topic areas focus on Critical Access Hospital (CAH) quality performance, finance, and community engagement. 

Visitors to the website will find an extensive collection of evidence-based policy briefs, reports, state-level data, and presentations from national conferences and meetings as well as news updates relevant to CAHs and the crucial role they play in rural healthcare.  Flex Monitoring Team announcements and updates will also be available via Facebook, Twitter, and RSS.

FMT press release 1-27-14

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Small Rural Hospitals Face Big Changes Under Affordable Care Act

January 27th, 2014

Link to Peoria Journal-Star article
“Small rural hospitals will see significant reductions in traditional Medicare payments,” reports the Peoria (IL) Journal-Star. “Some will see new payment requirements for patient care. Rural hospitals rely on Medicare payments for almost 45 percent of their annual income.”



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