1. SMALL Rural Hospital Improvement Program (SHIP) October 6, 2010 1

2. SHIP OVERVIEW 1. Program Purpose / Use of Funds 2. Hospital Eligibility 3. Funding Availability 4. Application Process 5. Contracting 6. VENDOR REQUEST FOR PAYMENT 7. progress Reporting 8. New categories 2

3. 2010 PROGRAM PURPOSE CHANGES The purpose of ship is to help small rural hospitals do any or all of the following: 1. SHIP continues to make funds available for costs related to implementation of prospective payment systems (PPS) 2. In 2010 and forward, ship funds will be used to pay for the costs related to delivery system changes as outlined in the patient protection and affordable care act (such as value-based purchasing (VBP), accountable care organization (ACO) and payment bundling. 3

4. Hospital Eligibility All designated critical access hospitals Small rural non federal short-term general acute care facilities with 49 staffed beds or less 4

5. Funding Availability Grant award for September 1, 2010 – August 31, 2011 is approximately $ - 8,281 5

6. The Ship Process APPLICATION – CONTRACT – INVOICING - PROGRESS REPORT 6

7. 7 SMALL RURAL HOSPITAL IMPROVEMENT GRANT PROGRAM (SHIP) Hospital Grant Application for FY 2010 Due back to State Office of Rural Health by: A. Grantee Information (Check) Continuing or New / CAH: Yes or No Hospital Name: _____________________________________________________________ Address: __________________________________________________________________ City: ________________ ____State: ______ Zip: ________ County: ___________________ Phone: ___________________ Fax: ____________________ Administrator / CEO: __________________________ E-mail: _________________________ Number of beds per line #12 of last Medicare Cost Report: ________ B. Grant Program Activities The information provided below will help your State Office of Rural Health (SORH) understand the goods and services required to best meet your hospital’s needs under SHIP. 1) List the percent of funds and the dollar amount of your hospital’s proposed budget for the SHIP grant that will be used in the following area(s); you can use it all in one category or split the funds up. Use $9,000 as approximate / tentative amount of the base award.

8. 8 Severalmonths later…

9. contracting 9

10. 10

11. INVOICING USE STATE PROVIDED VENDOR REQUEST FOR PAYMENT FORM TO REQUEST REIMBURSEMENT 11

12. 12

13. 13

14. 14 September 1, 2010 – August 31, 2011 ERROR June 30, 2011

15. 15 September 1, 2010 – August 31, 2011 Sept. 1, 2011

16. 16 September 1, 2010 – June 30, 2011 June 30, 2011

17. 17 June 15, 2011 June 30, 2011

18. 18 SMALL RURAL HOSPITAL IMPROVEMENT GRANT PROGRAM (SHIP) Revised Hospital Grant Application for FY 2010 Due back to State Office of Rural Health by: A. Grantee Information (Check) ReturningNewCAH: Yes or No If returning, is there a change in hospital address? Yes No If returning, is there a change in Administrator/CEO information? Yes No Hospital Name: ________________________________________Address: ______________________________________________ City: _______________________________State: _________ Zip: ________ County: ______________ Phone: ___________________ Fax: _________________ Administrator / CEO: _____________________________ E-mail: _________________________________ Number of staffed beds: ___________ B. Grant Program Activities The information provided below will help your State Office of Rural Health (SORH) understand the goods and services required to best meet your hospital’s needs under SHIP. List the percent of funds and the dollar amount of your hospital’s proposed budget for the SHIP grant that will be used in the following area(s). You can use it all in one category or split the funds across categories. Use $9,000 as approximate of the base award. Percent / Amount expended on implementation of Perspective Payment Systems (PPS) % $ Percent / Amount expended on Value-based Purchasing (VBP) % $ Percent / Amount expended on Accountable Care Organizations (ACOs) % $ Percent / Amount expended Bundled Payments % $ TOTALS:100 % $ 9,000

19. Progress report 19 FY 2009 Report - Due October 29, 2010

20. 20 B. Grant Program Expenditures 1) List the percent of funds and the dollar amount of your hospital’s SHIP grant expenditures that were used for the following area(s): Percent / Amount expended on purchase of computer software and hardware (such as applications that focus on quality improvement, performance improvement and patient safety): ______ % $_________ Percent / Amount expended on education and training of hospital staff on computer information systems (such as using technology to improve patient outcomes): ______ % $ _________ Percent / Amount expended on implementation of PPS (such as updating chargemasters or providing training in billing and coding) ______ % $ _________ Totals:100 % $ _________ 2) Describe any significant differences between the percentages budgeted for purchase of computer hardware / software, education and training of hospital staff on computer information systems, and implementation of PPS in your FY 09 Hospital Application Form and the actual percentages noted above. Please enter “none” if there were no significant differences.

21. Changes to ship 2010 Aco, vbp, bundled payment 21

22. Pps implementation SHIP continues to make funds available for costs related to implementation of prospective payment systems (PPS) - (such as updating chargemasters or providing training in billing and coding). 22

23. Value -based purchasing - VBP One of the key challenges for hospitals in the area of VBP is improving data collection activities in order to facilitate reporting to Hospital Compare. Examples of activities that satisfy PPACA: Activities that support data collection/reporting to Hospital Compare. Purchase of computer hw/sw, training /education, equipment, consultants or assessments in this category is appropriate use of SHIP funds. 23

24. Accountable care organization – aco The ACO concept is heavily focused on improving quality outcomes. Focus SHIP activities on supporting quality improvement such as reduction of medical errors, education and training in data collection and reporting and benchmarking. Example of activities that satisfy PPACA: Any activities that support quality improvement Education and training in data collection and reporting, benchmarking Reduction of medical errors Purchase of computer hw/sw, training /education, equipment, consultants or assessments in this category is appropriate use of SHIP funds. 24

25. Payment bundling One of the concepts behind bundled payment is building accountability across the continuum of care so SHIP funding could be used to improve care transitions. Examples of activities that satisfy PPACA: Improving care transitions between ambulatory and acute, acute to upstream acute and acute to step-down facility Training Clinical care transition protocol development Data collection that documents these processes. Purchase of computer hw/sw, training /education, equipment, consultants or assessments in this category is appropriate use of SHIP funds. 25

26. ??? Questions ??? 26