Annual Report

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Michigan Center for Rural Health
Annual Report
“The Michigan Center for Rural Health will be universally recognized as the center for expertise for rural health in Michigan through creative and visionary education, service, and research.”
“To coordinate, plan, and advocate for improved health for Michigan’s rural residents and communities.”
MCRH History
Michigan Center for Rural Health (MCRH) is a non- profit formed in 1991
Located on the campus of MSU in the College of Osteopathic Medicine
Organized on a directorship basis.
Governed by a Board of Directors
Key role in rural health care by  assisting in the creation and implementation of partnerships among non-profit groups, health departments, hospitals, government, and academia.
Provides the 'rural' perspective to many organizations, associations, and committees to help ensure effectiveness in delivering effective programs to Michigan's residents at the local and national level
John Barnas
Crystal Barter
Rachel Ruddock
Emma Smythe
Sara Wright
Victoria Lantzy
Executive Director
Director of Performance Improvement
Recruitment & Retention Manager
Rural Health Improvement Coordinator
Rural Education Manager
Rural Health Programs Coordinator
Jeff Nagy
Quality Improvement   Advisor
Jill Oesterle
Manager of Rural Health Clinic Services
Marc Maldaver
Administrative Assistant
Natalie Bobowski
Administrative Assistant
EMS Programs
Continuing Education
Hospital & RHC Programs
Workforce Services
Community Programs
Programs Managed include:
State Office of Rural Health
Medicare Rural Hospital Flexibilty Program
Small Hospital Improvement Program
Practice Transformation Network
Two Rural Accountable Care Organizations
Health Improvement Initiative Network
Quality Payment Program
Prescription Drug Overdose Prevention Initiative
Held May 4-May 5 at Soaring Eagle Casino & Resort.  
Annual Rural Health Conference
24 COM and CHM students received rural conference scholarships
Rural Health Professional of the Year in honor of Loren O. Gettel was awarded to John Barnas, Executive Director, Michigan Center for Rural Health
Sessions: New Tools for You: the New MAPS, Telehealth's Role in the World of MACRA, MIPS and Value Based Purchasing, Performance Improvement and Rural Health Organizations: Lessons Learned, and many more.
284  Attendees & 41 Exhibitors
Held on November 9-10, 2017  at Shanty Creek Resort
Critical Access Hospital Conference
169 Attendees & 31 Exhibitors
Who attends: Administrators, quality managers, network partners, & organization partners
Live Video/Audio Conferencing hosted throughout rural MI with REMEC, UPTN,  andSWTH
31 programs held in 2017 and 15 of them were Webinars
Partners: MSU College of Nursing, MSU School of Social Work, MSU Department of Psychiatry, Geriatric Education Center of Michigan, Michigan Association of Ambulance Services, Mobile Medical Response, Michigan  Association  of Dental Hygienists, Ferris State University, MDHHS Oral Health Programs, ISC, and Hall Render Killian Heath & Lyman Law Firm
September 16-17, 2017: Level II 20 participants 
October 7-8, 2017: Level III 19 participants 
EMS Webinars
Everyone's A Leader in EMS: 33 participants
EMS Recruitment & Retention: 20 participants
Pediatric Allergic Reactions: 32 participants
Basic Disaster Life Support: 17 participants
Human Trafficking: 28 participants
Pharmacology: 28 participants
Airway Management: 30 participants
Child Protection Services: 30 participants 
218 Total Participants
EMS Leadership Academy Workshops
39 Total Participants 
-Federally funded grant opportunity designed to address the increasing problems of opioids and heroin misuse, abuse, and overdose in the State of Michigan.

-Intends  to do by building key partnerships at state and local levels, collecting and sharing data, and increasing and enhancing education on all information pertinent to the opioid epidemic.

-MCRH has partnered with MDHHS on implementation of the Prescription Drug Overdose (PDO) grant work. 

-MCRH objective is to provide face-to-face training to the 625 rural providers in 12 Michigan Counties outlined here. 

-Provide training to the providers in Michigan's 195 certified RHCs, 36 CAHs, via webinar and conference presentations. 
echnical Assistance
MCRH provides free resources and information to MI’s healthcare students, providers, hospitals and clinics in the areas of loan repayment programs, visa programs, health professional shortage areas, and medical professional development. Additionally, we participate in workforce policy development with state and federal partners and serve as an advocate for improving access to care in rural Michigan.
 Road Trip
Rural Health
1. 28 MSU COM and CHM students attended the 2017 Michigan Rural Health Conference as Rural Health Scholars.
2.  MCRH/AHEC hosted a rural road trip for 15 Wayne State medical students at McKenzie Health System. 
Rural Breakfast
Rural Roadtrip
3. Three first and second year MSU COM and CHM students had breakfast with Dr. Kim Suhanic from Manistique Lakes Rural Health Clinic in Curtis, MI.   

4. Six first and second year MSU COM and CHM students visited Marlette Regional Hospital. 

5. MCRH provided five scholarships to rural high school students who attended OsteoCHAMPS at MSU COM.
- There are 195 Rural Health Clinics (RHCs) in Michigan
What MCRH provided:
1. RHC Practice Management Workshop        -51Participants 2. RHC Financial Management Workshops     
3. ICD-10 Billing and Coding Bootcamp        - One and half days.        -240 participants        -two  follow up webinars 4. Support for RHC Quality Network 5. Lean Analysis for RHCs 6. Remote Operational Assessment Tool
RHC Quality Network: Quarterly Meetings
1. Core Measure Discussion      -Preventive Care and Screening: Tobacco Use:                         Screening and Cessation Intervention (NQF #0028)      -Controlling High Blood Pressure (NQF #0018)         
    -Preventive Care and Screening: Body Mass Index
      (BMI)Screening and Follow-Up (NQF #0421)

2. Subject matter expert presentation     3. Best practices surrounding quality improvement in              Michigan RHCs (presented by RHC staff)   4. Round table discussion on any issue related to RHCs
Since January 2001, the MCRH, the Michigan Peer Review Organization (Michigan’s QIO), Michigan Health & Hospital Association (MHA) and Michigan’s Critical Access Hospitals have worked together through the Michigan Critical Access Hospital Quality Network (MICAH) to create and implement a horizontally integrated coalition that supports the collection and analysis of health care data from the patient populations in order to achieve improved health outcomes in their respective rural communities.
During the 15-year history of the MICAH, voluntary membership has grown from the original 14 members in 2001 to 39 members (three members are rural PPS hospitals).
Core Areas of the Flex Program
1. Quarterly MICAH QN meetings 2. Benchmarking MICAH QN  Core Metrics and Medicare Beneficiary Quality Improvement Project  Metrics 3. Critical Access Hospital Annual Survey 4. Clinical Education 5. Critical Access Hospital Annual Meeting 6. Technical Assistance
1. HCAHPS data collection 2. Comprehensive Advanced Life Support (CALS) Training 3. EMS Webinars 4. EMS Leadership Academy
1. Supporting two CAH CFO Network meetings 2. Annual Financial Data Collection & Benchmarking 3. Financial Improvement Education 4. Operational Improvement Technical Assistance 5. Financial Support for Monthly Web Based Data Collection 6. Board of Directors Education & Training 7. Billing & Coding Education 8. Michigan Critical Access Conference
upport for Population Health & EMS Integration
upport for Quality Improvement
upport for Operational & Financial Improvement
MCRH manages Michigan’s Medicare Rural Hospital Flexibility Program, commonly referred to as the “Flex” program. Provides services to 36 Critical Access Hospitals (CAHs) , the Flex Program also assisted 289 rural EMS agencies and 10 rural PPS hospitals.
Three-state coalition of 32 healthcare partners (MI, IN, IL) Goal of transforming the practices of 11,500 clinicians across Indiana, Illinois, and Michigan into learning practices capable of providing better health and improved care at a lower cost Train and deploy 52 Quality Improvement Advisors (QIAs)
QIAs will provide direct technical assistance in: 1. Meaningful Use 2. Physician Quality Reporting System 3. Local quality improvement efforts to help prepare clinicians for participation in      value-based payment systems.
The network will utilize a “Transformational Change Toolkit" to integrate three practice transformation approaches: 1. Implementation Science, which is an emerging second generation of continuous quality improvement 2. Lean and Six Sigma process improvement tools 3. Patient-centric, personalized population health management.
1. MACRA/MIPS- Currently 17 practices, 25 physicians, 21 Mid-levels, and 6 other. 
    a) Education
    b) MIPS

2. Practice Assessment Tool (PATs)

3. Action Plans-to help move practices thru the Phases of Transformation 

4. ZOHO-various tools to assist QIA and PTN

5. TIA Tool- CMS web-based data collection and tracking mechanism
6. Recruitment

7. Workflow evaluation & coaching to improve office and clinical efficiencies

8. Work with practices to move them through the five phases of transformation

9. CME/MOC Part IV Programs in Medication Adherence, Depression Screening, Opioid      Prescribing 

10. Preparing the practice for the change in reimbursement (i.e. MIPS 2019).

Eight Service Line Assessments were completed for RHCs and Hospitals.
RHCs 1. Schoolcraft Memorial Hospital- RHC                                  patient/office flow 
2. Hills & Dales General Hospital- Clinic coding                   project
3. Bangor Clinic- Clinic patient/office flow
4. Munson Charlevoix Hospital- Clinic patient/office         flow
Department Projects 1. Caro Community Hospital- Laboratory patient                access/flow
2. Munising Memorial Hospital- Revenue cycle project
3. Eaton Rapids Medical Center- Therapy patients/          information flow
4. Sparrow Clinton Hospital- Endo patient flow
Focus on operational & financial performance improvement areas:   -Margin management- revenue cycle optimization   -Competitive positioning   -Program development & growth opportunities   -Productivity improvements   -Identify operational changes required to improve performance   -Labor utilization and staffing model assessment Contains feedback relating to quality, service, and cost improvement opportunities Evaluation of organizational & management structure will be included as part of each service line analysis Each assessment/analysis will also contain key benchmarking information so target hospitals can compare their performance and current state to other, similar organizations.
Medicare Shared Savings Program (MSSP) is a new permanent program under Medicare that allows providers to continue to paid fee-for-service and/or cost-bast reimbursement, while gaining the infrastructure, tools and knowledge to manage population health. Groups of health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. Goal of coordinated care is to ensure that patients, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Meet eligibility requirements and submit application to CMS
Developed in response to stakeholder concerns suggesting that some providers lack adequate access to the capital needed to invest in infrastructure necessary to successfully implement population case management 10,000 or fewer beneficiaries for the most recent quarter, as determined in accordance with the Shared Savings Program regulations No financial cap The ACO does not include a hospital unless the hospital is a critical access hospital (CAH) or inpatient prospective payment system (IPPS) hospital with 100 or fewer beds Target new ACOs serving rural areas and areas of low ACO penetration Quality of the spend plan in application Three Year Demonstration Project
Greater MI Rural ACO
Southern MI Rural ACO
1. Sheridan Hospital 2. Scheurer Hospital 3. Hills & Dales General Hospital 4. Marlette General Hospital 5. McKenzie Health System 6. Helen Newberry Joy 7. Schoolcraft Memorial Hospital 8. Dickinson County Hospital
1. Hayes Green Beach 2. Sturgis Hospital 3. Three Rivers Health 4. Hillsdale Hospital 5. Coldwater Hospital 6. Allegan Hospital 7. Memorial Medical Center 8. Deckerville Community Hospital 9. Bronson South Haven
State-Based Executive Director Bi-weekly calls & weekly calls with providers Monitoring "to dos" Support information dissemination with weekly webinars Meeting support Liaison between two ACOs
Michigan Clinically Integrated Health Network
5 Rural PPS Hospitals
1 FQHC (7 sites)
6 CAHs
42 Primary Care Practices (30 RHCs)

19,619 Assigned Medicare Beneficiaries 

Patterning with other payers to replicate the ACO model  of care with other patient populations. 
1. Michigan Medicaid
2. BCBS of Michigan
3. Michigan Community of Health Network
1. Alcona Citizens for Health, Inc. 
2. Dickinson County Healthcare System
3. Helen Newberry Joy Hospital
4. Hayes Green Beach Memorial Hospital
5. McKenzie Health System
6. Sheridan Community Hospital
7. ProMedica Coldwater Regional Hospital
8. Hillsdale Hospital
9. Allegan General Hospital
10. Schoolcraft Memorial Hospital
11. Three Rivers Health
12. Sturgis Hospital
CIN Hospitals
Quarterly newsletters on  current federal and state information, educational & funding opportunities, and other services.  Provides up to date information on Critical Access Hospital Programs and EMS Programs.  Use email marketing software and are able to drive content to specific audiences.
Multiple listserves allow MCRH to serve as Clearinghouse for state & federal information on data, grants, studies, surveys, briefs, and updates.   We use general listserves for announcements, reports; specialized listserves for Critical Access Hospitals, Rural Health Clinics, Chief Financial Officers, and Chief Nursing Officers, ACOs, etc.
Bi-weekly snapshots highlight current events, programs, and funding opportunities. Sent out every 2 weeks to specific audiences using the email marketing software.
Celebrated National Rural Health Day on November 16, 2017
Created to celebrate the uniqueness of rural citizens and the rural healthcare environment.
NRHD Activities: Facebook Trivia, Community Stars, Photo Booth at CAH Conference, Governor's Proclamation, Special Radio Clip, Alpena FD CPR Class 
Michigan Center for Rural Health
Statements of Activities for the Years Ended September 30, 2017 and 2016
Senator Geoff Hansen Michigan State Senate Edward Canfield, D.O. Michigan Osteopathic Association Kathy Wahl, BS, MSN, RN 
 Bureau of EMS, Trauma and Preparedness Alfonso C. Ferreira, M.D., President Michigan State Medical Society Beth Nagel , Secretary/Treasurer 
 Michigan Department of Health and Human Services, Policy and Planning David B. Jahn, Vice President
 Michigan Health & Hospital Association  
Nicholas Derusha, MPA, REHS, CFPH Michigan Association for Local Public Health Representative Sue Allor Michigan House of Representatives Nancy L. Spencer Michigan Primary Care Association William D. Strampel,D.O.  
 MSU College of Osteopathic Medicine Thomas J. Veryser, D.D.S, M.H.S.A. Office of the Governor
Jody Hansen, RN
 Michigan Nurses Association