Guide for HCFA's Rural Health Care Grant Program Transition MS Guide for HCFA's Rural Health Care Program Transition Grants - U.S. Department of Health and Human Services Health Care FinancingAdministration Office ofResearch and Demonstrations Baltimore, Maryland December 1994 HCFA Pub. No. 03362 Acknowledgments This Guidewas funded by the Health Care FinancingAdministration under ContractNumber 500-87-0028-12 and prepared by the Mathematica Policy Research, Inc. The Project DirectorwasJudith Wooldridge. The Federal Project Officerwas Siddhartha Mazumdar. The coauthors include: Irma Perez-Johnson, Jeffrey Bauer, and EileenWeis. CONTENTS Chapter Page THE RURAL HEALTH CARE TRANSITION GRANT 1 PROGRAM AND THE PURPOSE OF THIS GUIDE 1 CONGRESS ESTABLISHED THE GRANT PROGRAM 1 PURPOSE OF THE GUIDE 2 APPLYING FOR A RURAL HEALTH CARE TRANSITION GRANT 5 CHOOSING A GRANT PROJECT 5 Need 5 Feasibility 5 Support 7 THE GRANT APPLICATION 7 Preparing the Application Narrative 8 Other Sections of the Grant Application 10 Getting Help 10 Unsuccessful Applications 10 GRANTEE SELECTION PROCESS 11 Application Review 11 Selection 11 Grant Awards 12 PLANNING AND IMPLEMENTING GRANT PROJECTS 13 STRATEGIC PLANNING: A FACTOR IN SUCCESS 13 Needs Assessment 14 Feasibility Assessment 15 Environmental Assessment 16 PLANNING AND IMPLEMENTING A PROJECT 16 Management Planning 17 A Project Coordinator 17 in CONTENTS (continued) Chapter Page 3 Consultants 17 (continued) Data Gathering 18 Coordinating with Physicians 18 Cooperating with Other Providers 18 LESSONS LEARNED: GRANT-FUNDED SERVICES 4 IMPLEMENTED 19 AFTER THE GRANT ENDS 19 WHICH WERE THE PROBLEM PROJECTS? 22 NEW SERVICES 24 Outpatient and Emergency Services 24 Inpatient Services 27 Community, Preventive, Transportation, and Diagnostic Services 30 LESSONS LEARNED: GRANT-FUNDED RECRUITING, 5 MANAGEMENT, AND OTHER PROJECTS 33 RECRUITING PHYSICIANS 33 MANAGEMENT PROJECTS 36 STAFF TRAINING AND QUALITY OF CARE PROJECTS 37 HOSPITAL CONSORTIA 38 CASE STUDIES OF SUCCESSFUL AND UNSUCCESSFUL 6 GRANT PROJECTS 41 , SUCCESSES 41 Case Study 1 41 Case Study 2 43 Case Study 3 44 IV CONTENTS (continued) Chapter Page 6 FAILURES 46 (continued) Case Study 4 46 Case Study 5 47 Case Study 6 48 Case Study 7 48 Case Study 8 48 Case Study 9 49 Case Study 10 50 7 GRANT IMPACTS ON THE HOSPITAL AND COMMUNITY ... 51 HOSPITAL IMPACTS 51 Effects on Finances 52 Other Effects 53 COMMUNITY IMPACTS 54 APPENDIX A: LESSONS FROM CASE STUDY GRANTEES ... 57 OUTPATIENT SURGERY 59 EMERGENCY ROOM 61 RURAL HEALTH CLINICS 63 PHYSICAL THERAPY 66 CARDIAC REHABILITATION AND CARDIAC CLINICS 68 PRIMARY CARE CLINICS 71 UNSPECIFIED OUTPATIENT SPECIALTY CLINICS 73 ONCOLOGY AND CHEMOTHERAPY SERVICES 75 OCCUPATIONAL THERAPY 77 MENTAL HEALTH CLINICS AND OUTREACH PROGRAMS 78 EAR, NOSE, AND THROAT CLINICS 80 MOBILE HEALTH CLINICS 81 SWING BEDS 82 NURSING HOMES, SKILLED NURSING, AND TRANSITIONAL CARE UNITS 83 INPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS 86 CONTENTS (continued) Chapter Page APPENDIX A (continued) INPATIENT SURGERY 88 VENTILATOR UNITS 90 ASSISTED LIVING 91 COMMUNITY AND PATIENT EDUCATION 92 WELLNESS AND FITNESS PROGRAMS 93 LIFELINE™ SERVICES 95 HOME HEALTH AND HOSPICE SERVICES 97 SOCIAL SERVICES AND OUTREACH 99 ADULT DAY CARE 101 ROUTINE MEDICAL TRANSPORTATION 103 EMERGENCY MEDICAL TRANSPORTATION 105 MAMMOGRAPHY 107 DIAGNOSTIC SERVICES (OTHER THAN MAMMOGRAPHY) 108 APPENDIX BIBLIOGRAPHY AND GENERAL B: RESOURCES 109 THE GRANT PROGRAM AND THE EACH PROGRAM 109 PROJECT-SPECIFIC PUBLICATIONS 110 Outpatient and Emergency Services 110 Inpatient Services Ill Other Projects 112 PUBLICATIONS OF GENERAL INTEREST 117 SOURCES OF TECHNICAL ASSISTANCE AND INFORMATION 125 Federal Agencies 125 National Organizations 125 Foundations 128 Other Resources 128 VI TABLES Table Page 1 SERVICES WITH IMPLEMENTATION RATES OF 50 PERCENT OR LOWER 22 2 SERVICES LEAST LIKELY TO BE FINANCIALLY SELF-SUPPORTING 23 3 SERVICES TO BE DISCONTINUED 24 NUMBER OF GRANT-FUNDED OUTPATIENT AND 4 EMERGENCY SERVICES IMPLEMENTED 25 5 NUMBER OF GRANT-FUNDED INPATIENT SER- VICES IMPLEMENTED 29 NUMBER OF GRANT-FUNDED PREVENTIVE, 6 COMMUNITY MEDICAL AND SOCIAL, TRANSPOR- TATION, AND DIAGNOSTIC SERVICES IMPLEMENTED 31 7 PHYSICIANS RECRUITED WITH THE GRANTS 36 Vll