SHIP Grant Summaries

Stroudwater Associates assists Rural & Community Hospital leadership teams in receiving the Small Rural Hospital Improvement Program (SHIP) Grant.

Our team can help your organization with training and education related to various investment activities. 

Our Approach to the SHIP Grant

Value-Based Purchasing (VBP) Investment Activities

ACTIVITY DESCRIPTION: Service Excellence begins with a clear understanding of our patients’ perspective of care delivery. To evaluate our patients’ perspectives, CMS developed the HCAHPS survey as a credible, useful, and practical method for gauging the patients’ experience. HCAHPS stands for “Hospital Consumer Assessment of Healthcare Providers and Systems.” Three broad goals have helped to create the HCAHPS of today: to produce data about patients’ perceptions that allow objective and meaningful comparisons; to create new incentives for hospitals to improve due to public reporting; and to enhance accountability by increasing transparency. To ensure hospital shave clarity around service excellence, Stroudwater will provide individualized training sessions to improve hospital staff’s understanding of the HCAHPS survey, the meaning behind the questions posed to the patient, and what part they play in improving the patient journey.

EXPECTED OUTCOMES: Attendees will understand all HCAHPs measures by leveraging the specific training needs identified for each hospital. Staff members will receive formal HCAHPS training with discussion including best-practice actions to ensure their understanding of the patient’s perspective of care.

ACTIVITY DESCRIPTION: The engagement will consist of data analysis combined with provider and staff interviews as the framework for the development of findings and recommendations. Specific attention will be directed to the evaluation of current practices and processes potentially impacting workflow and efficiency. Special focus will address the Core Measures or CAH MBQIP measures, as well as other measures related to Emergency Department throughput and outcomes.

EXPECTED OUTCOMES: Stroudwater will provide hospital or cohort hospitals with a written summary of all reviewed areas, in addition to a 60-minute debrief call with ED Manager and selected members of the leadership team. The written summary will include high-level findings and analyses and prioritized recommendations and actions for improvement. Stroudwater will conduct an education and training session to address the common findings and methods of achieving success for optimal patient flow.

ACTIVITY DESCRIPTION: The Patient-Centered Medical Home Model is a team-based care model that provides comprehensive, coordinated, proactive medical care to patients to achieve maximal health outcomes. The PCMH model is most often implemented in primary care settings. Stroudwater offers a 3-hour training and education Learning Session: Introduction to the Patient-Centered Medical Home Model of Care. The Learning Session includes an in-depth review of the PCMH Model and a high-level overview of the National Committee for Quality Assurance PCMH Standards and Guidelines.

EXPECTED OUTCOMES: Upon completion of this Learning Session, attendees will demonstrate a general understanding of the PCMH Model of Care, including major components and core principles of the model; potential qualitative and quantitative benefits of the model; and potential staffing, operational, and HIT factors to consider in preparation for model implementation. Attendees will also demonstrate a high-level awareness of the NCQA PCMH Standards and Guidelines. A copy of Shared Principles of Primary Care, published by the Primary Care Collaborative, will be provided.

ACTIVITY DESCRIPTION: Stroudwater offers a 4-hour training and education course entitled An Overview of the Team-Based Care Model of Care, including benefits and core components of the Model, as well as factors to consider and initial steps when planning and preparing for implementation. The course is delivered either in person or remotely via webinar, as mutually agreed with the client.

EXPECTED OUTCOMES: Significant productivity increases can be achieved as a result of the changes in workflows and redistribution of work that occur when implementing this model within clinical teams. Team-Based Care also supports long-term financial sustainability for the practice through potential increases in practice revenue, optimized provider-to-patient time, and reduced opportunity costs due to provider turnover. Standardized protocols reduce clinical variation and may improve clinical outcomes and diminish operating costs. Most importantly, the Team-Based Care Model establishes a strong foundation for success under value-based payment models.

ACTIVITY DESCRIPTION: Stroudwater conducts analysis, collaborates with hospital staff, and generates a report containing financial analysis and recommendations. Work steps for the Provider Alignment Impact Analysis include a review of historic utilization by procedure code and payor, the impact of the practice location on CAH cost-based reimbursement as applicable, evaluation of average charge and payment per face-to-face encounter, the impact of alternative designations on reimbursement, delineation of provider-based assumptions,evaluation of the provider complement at the practice location, and an evaluation of provider productivity.

EXPECTED OUTCOMES: Process measures for the project include the identification of participating hospitals, the completion of the initial analyses, virtual interviews as necessary, and the generation and distribution of hospital-specific reports. Outcomes measures include the number of hospitals targeted for Provider Alignment Impact Analysis based on analytics. Specific hospitals will see improvement in financial and operational performance for PB-RHCs and other off-campus healthcare sites.

ACTIVITY DESCRIPTION: Stroudwater offers a Value-Based Payer Readiness Assessment training session that includes both didactic learning and breakout work time to complete assigned tasks. The session includes analysis of market landscape data, including, population, insurance, ACO, and Medicare Advantage data for consideration when developing the organization’s population health strategy. Stroudwater will leverage publicly reported MSSP data to compare benchmark results of regional/state/national ACOs to learn how to best utilize the hospital’s value-based data. The training session will include education on various risk models and reimbursement opportunities including CMS and commercial alternatives, required data capabilities, drivers of both benchmark rates and total cost of care, and risk mitigation strategies.

EXPECTED OUTCOMES: Upon completion of this training session, attendees will understand strategies for assuming and managing financial risk under value-based care models, gain a financial tool to evaluate various value-based care scenarios, and recognize various market options for value-based participation.

ACTIVITY DESCRIPTION: Stroudwater offers a four-part Learning Series on the Primary Care Opioid Management Program. The Primary Care Opioid Management Program provides an evidence-based quality improvement roadmap to help primary care practices develop, implement, and deliver guideline-driven care for chronic pain patients on long-term opioid therapy. Learning Session topics include a discussion of the recommended approach and implementation stages; key milestones and success factors; potential benefits of the program; and an overview of available clinical tools and educational resources. The Learning Series is structured to support a “Train the Trainer” approach to program implementation by Learning Series attendees.

EXPECTED OUTCOMES: Upon completion of this four-part Learning Series, attendees will demonstrate an understanding of the Primary Care Opioid Management Program, including the core elements of the program; the development and implementation stages; key milestones and program success factors; potential qualitative and quantitative benefits of the program; and an awareness of available clinical tools, workflows, implementation checklists, and educational resources to support program implementation. Attendees will receive a copy of the Primary Care Opioid Management Self-Assessment Tool.

Accountable Care Organization (ACO) OR Shared Savings Investment Activities

ACTIVITY DESCRIPTION: Unless specifically measured, disparities in health and healthcare can go unnoticed even as stakeholders seek to improve healthcare. Stratifying healthcare data by race, ethnicity, language, and other demographic factors such as age, sex, health literacy, sexual orientation, gender identity, socioeconomic status, and geography is vital for understanding and addressing health disparities. Stroudwater will assist hospitals in closely examining stratified quality and health outcome data to discover the type and magnitude of disparity and then allocate or reallocate resources accordingly. Hospitals will utilize the above data to create a health equity dashboard which will increase the level of understanding related to the health outcomes of the hospital’s patient population, including social risk factors such as socioeconomic and geography in which the hospital can leverage the data to improve health outcomes, access, and quality of care.

EXPECTED OUTCOME: Attendees will have an understanding of the health outcomes of the hospital’s patient population, including social risk factors such as socioeconomic status and geography. The hospital will be able to leverage the data to improve health outcomes, access, and quality of care. Each hospital will develop a health equity dashboard to identify and evaluate areas within the hospital’s population and service area with the greatest need. Attendees will participate in a 90-min virtual consultation review of the health equity dashboard and discuss any recommendations, findings, and next steps.

ACTIVITY DESCRIPTION: Key factors that can negatively affect swing-bed utilization include efficient referral processes, lack of information among key stakeholders, misinformation, lack of awareness regarding the level of clinical complexity that can be provided in swing bed programs, availability of nursing staff with more advanced training at rural hospitals, and the need for a better system for quantifying the economic benefit of a balanced distribution of cases within the healthcare environment. All will be addressed in this evaluation. Stroudwater’s swing bed program evaluation and training workshop focuses on the following areas to assist hospitals in achieving a robust and thriving service line; identification of gaps in the referral process; nurse training related to managing patients with varying levels of clinical complexity; evaluation of information flow processes; and overall process improvement opportunities to drive growth.

EXPECTED OUTCOMES: Attendees will build on current marketing efforts directed at primary referral sources and develop action steps in achieving program recognition; formulate an action plan to implement best practices that will improve performance and fill gaps to achieving optimal process flow; and develop a performance monitoring plan with key metrics to assist the leaders in driving ongoing performance with the goal of increasing swing bed utilization and improving patient outcomes.

ACTIVITY DESCRIPTION: Comprehensive Care Management has emerged as a leading strategy to manage the health of populations, according to the Agency for Healthcare Research and Quality. Care management is organized around the principle that appropriate interventions for individuals within a given population will reduce health risks and decrease the cost of care. Stroudwater offers a 4-hour training and education Learning Session customized to reflect the state’s environment: Developing and Implementing a Care Management Program for Value-Based Care Models. The Learning Session includes a discussion of key organizational strategic and tactical decisions and action steps necessary to define, develop, and implement the organization’s Care Management model and program.

EXPECTED OUTCOMES: Attendees will demonstrate a general understanding of key organizational strategic and tactical options to define their Care Management model and program; standard care management roles and responsibilities; core elements of the care management process; the importance of developing standard care management workflows and communication processes; and the impact of Social Determinants of Health and an understanding of Medicare-covered Care Management Services.

ACTIVITY DESCRIPTION: The development of a Clinical Care Delivery Spectrum utilizes an outcomes-driven method to establish a consistent, evidence-based process to determine which patients can be cared for safely and appropriately at each facility. The Clinical Care Delivery Spectrum can be structured to include various patient care levels such as acute inpatient including ICU, observation, swing bed, emergency, and other clinical services. Stroudwater will provide education and coaching on the development of the hospital’s Clinical Care Delivery Spectrum; provide an understanding of the critical factors and potential barriers that influence the decision-making process; and collaborate with the hospital to facilitate the development of their unique Clinical Care Delivery Spectrum at the conclusion of the project.

EXPECTED OUTCOMES: Attendees will have an understanding of the hospital’s Clinical Care Delivery Spectrum and the critical factors and potential barriers that influence the decision-making process and will develop their own unique Clinical Care Delivery Spectrum.

Payment Bundling (PB) / Prospective Payment System (PPS) Investment Activities

ACTIVITY DESCRIPTION: On January 1, 2022, ICD-11 was released by the World Health Organization. Stroudwater has created a plan aimed at addressing the challenges healthcare organizations will face with the implementation of ICD-11. This training will prepare the organization for the implementation of ICD-11 and help mitigate concerns organizations have related to the changes in methodology. Stroudwater will provide readiness training and education around ICD-11, guidance, and direction on the process and best practices to follow when implementing changes. This offering will continue to be enhanced as additional guidance is provided by the Department of Health & Human Services related to implementation in the USA.

EXPECTED OUTCOMES: Attendees will attend a training on the expected impacts related to ICD-11 implementation and will be informed of best practices for plan implementation and key learnings experienced with ICD-11 implementation.

ACTIVITY DESCRIPTION: Stroudwater will lead a revenue cycle performance improvement initiative that incorporates hospital priorities while enabling participants to engage individually or as a small cohort group. Individual hospitals will focus on coding and business office staff interviews, process audits, detailed administrative briefings, and the provision of customized education and issue mediation. Cohort offerings will focus on group training, roundtable discussions, and the provision of comprehensive educational resources aimed at increasing productivity, communication, and quality. Areas reviewed for both options will include, but not be limited to, components such as documentation review, clinician communication platforms, revenue cycle participation, denial management, inpatient and outpatient coding processes, modifier placements, information trending, and operational command and control.

EXPECTED OUTCOMES: Participants will receive a detailed action plan with solutions and next steps to address issues and improve revenue cycle performance. Specific work plans will be developed for revenue cycle leadership, coding, and business office staff. Solutions to foundational revenue cycle issues will be provided along with education and resources to resolve them permanently. Participants can expect lower revenue cycle process costs, improved revenue recognition, increased reimbursement, improved quality, and better customer service.

ACTIVITY DESCRIPTION: Stroudwater will perform a comprehensive review of the hospital’s chargemaster to identify issues within the chargemaster and provide detailed recommendations to resolve and prevent them. The objective of the assessment is to identify CPT codes that need to be updated and/or deleted and to review pricing for appropriateness and consistency. Stroudwater will conduct a focused analysis of targeted areas within the hospital chargemaster, reflecting the updated Medicare rates, to identify concrete opportunities for operational and financial performance gains. In addition to the identification of improvement areas, Stroudwater will provide recommendations for the implementation of improvements to the chargemaster process within each department to increase gross charges and net reimbursement while ensuring regulatory compliance. We will provide specific direction and follow-up recommendations to ensure that findings are implemented successfully. Our goal is to provide actionable improvements that can be incorporated into operations and create ongoing value for the hospital.

EXPECTED OUTCOMES: Participants will receive an analysis of the findings from the Chargemaster Review and action plans for next steps.

ACTIVITY DESCRIPTION: Stroudwater will provide a formal approach and project management for implementing a hospital’s transparent pricing strategy. The goal of the project will be to assist the hospital in implementing the transparent pricing initiative from start to finish. The pricing strategy implementation will consist of a review of information currently available and a comparison to the CMS requirements. As a result of the conversations and data review, Stroudwater will develop an action plan to address issues and provide additional resources, training, and education where necessary. This action plan will include steps for the creation of a 300 Shoppable Services list for the facility, 70CMS-required services, 230 hospital-identified services, updated pricing for current rates and fee schedules, a roll-out plan, staff education recommendations, and consumer/patient education recommendations. Project activities will engage the hospital’s leadership, information technology, and marketing teams to generate the facility’s strategy.

EXPECTED OUTCOMES: As a result of the project, Stroudwater will partner with the hospital to deliver a pricing model that the hospital can complete and share with consumers via its public website to meet the current CMS transparent pricing requirements.

ACTIVITY DESCRIPTION: Medicare Cost Reports enable CMS to establish cost-based CAH payment rates for Medicare beneficiaries and provide a wealth of information about a hospital’s clinical model, cost structure, and overall financial performance. Stroudwater evaluates the hospital’s most recently filed Medicare Cost Report utilizing our proprietary Cost Report web-based software application to identify opportunities to eliminate errors and omissions, resolve conflicts, review cost allocation methods, and identify operational and strategic initiatives and/or accounting practices to improve financial performance.

EXPECTED OUTCOMES: Each participating hospital will have access to Stroudwater’s secure web-based application that provides a summary of the analysis results and prioritized recommendations. A Stroudwater cost-report expert will conduct a report debrief and planning session with the hospital CEO and CFO. The software will provide online training and education for cost reporting best practices with a specific focus on S-10 worksheet data tracking, submission, and performance improvement priorities

ACTIVITY DESCRIPTION: Stroudwater will provide training and education related to coding and billing for a provider-based rural health clinic (RHC). This training will consist of revenue cycle insights to assist in the RHC billing activities. Stroudwater will provide industry best practices for certain processes and provide ways for the clinics to work these elements into their processes.

EXPECTED OUTCOMES: Each participating location will demonstrate an improved understanding of specific billing rules required for an RHC as compared to traditional clinic billing. They will understand the importance of an engaged team to facilitate the billing requirements.

ACTIVITY DESCRIPTION: The Charge Description Master (CDM) is the foundation of the revenue cycle process and drives financial performance. Hospitals that participate in the Strategic Pricing program upload their electronic CDM file to a secure web portal and use the web application to review and modify their CDM files and apply the information to perform external benchmark analysis against a national database of CDM data from small rural hospitals. Hospitals also use the web application to update charge levels based on quarterly updates from the American Medical Association (AMA) to maintain defensible, market-driven prices for new and existing services/procedures.

EXPECTED OUTCOMES: Participating CAHs will improve the integrity of CDM files as measured by a reduction in the most common errors. They will have a sound pricing strategy.