Critical Access Hospital Quality Improvement Program

**NC Healthcare Foundation grant-funded program**

The Medicare Rural Hospital Flexibility (FLEX) Program was established by the Balanced Budget Act (BBA) of 1997 in the creation of critical access hospitals (CAHs). CAH designation allows the hospital to be reimbursed on a reasonable cost basis for inpatient and outpatient services provided to Medicare patients (including lab and qualifying ambulance services) and, in some states, Medicaid patients.

Flex funding encourages the development of cooperative systems of care in rural areas, joining together CAHs, emergency medical service (EMS) providers, clinics, and health practitioners to increase efficiencies and improve the quality and safety in patient care. The Flex Program requires states to develop rural health plans and funds their efforts to implement community-level outreach. The Flex Program includes support for the following five program areas:

Through the FLEX Program, the North Carolina Healthcare Association (NCHA) in partnership with the NC Office of Rural Health, is assisting hospitals in assessing current performance, identifying gaps, and developing improvement plans to address identified opportunities for the Medicare Beneficiary Quality Improvement Program (MBQIP) core measures for inpatient, outpatient, care transitions, and patient experience measures. The patient experience measures are inclusive of metrics from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Training on basic quality improvement, data tracking and reporting with access to best practices and subject matter experts will help to establish a foundation for sustainable improvement.  The action period for this collaborative is August 2022 through August 2023.