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Small Rural Hospital Transition (SRHT) Project
Delta Memorial Hospital: Preparing For Population Health
Bethany AdamsAshley AnthonyAugust 16, 2018
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Presentation Objectives
• SRHT Project Purpose and Goals◦ 2018 – 2019 Application Period and Process ◦ Onsite Consultation Process◦ Benefits of Participation◦ Resources
• Delta Region Community Health systems Development (DRCHSD) Program Overview
• Delta Memorial Hospital ◦ SRHT Experience◦ Outcomes and Impact◦ Next steps To Population Health
• Questions2
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The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. As the nation’s leading technical assistance and knowledge center in rural health, The Center focuses on five core areas:
• Transition to Value and Population Health
• Collaboration and Partnership
• Performance Improvement
• Health Information Technology
• Workforce
The Center’s Purpose
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Small Rural Hospital Transition (SRHT) Project Supported By
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SRHT Project Purpose and Goals
• Supports small rural hospitals nationally in bridging the gaps between the current volume-based health care system and the newly emerging value-based system of health care delivery and payment.
• Provides technical assistance through onsite consultation to assist selected hospitals in transitioning to value-based care and preparing for population health.
• Disseminates best practices and successful strategies to rural hospital and network leaders.
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www.ruralcenter.org/rhi/srht
Hospital Eligibility
Small rural CAH or PPS hospitals:• Located in a FORHP defined rural community,
persistent poverty county (PPC) or a rural census tract of a metro PPC
• Have 49 staffed beds or less as reported on the most recently filed Medicare Cost Report
• That are either for-profit or not-for-profit
SRHT Project Eligibility
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SRHT 2018 – 2019 Application Period:September 26 - October 24, 2018
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www.ruralcenter.org/rhi/srht/application
Nine Hospitals Selected For Onsite Technical Assistance
• Nine (9) hospitals are selected to receive onsite consultations for either a financial operational assessment (FOA) or quality improvement (QI) project
• At least three (3) hospitals are selected for both FOA and QI projects
• Resources are utilized to support the onsite technical assistance
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Hospitals May Select Either the FOA or QI Process Improvement Project
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Financial Operational Assessment (FOA) - Identifies strategies and develops tactics that increase operational efficiencies, improve financial position, and assist leaders with maximizing reimbursement where possible to help their hospitals be financially stable during the transition to population health.
Quality Improvement (QI) Project - Assesses utilization review, discharge planning, care coordination and resource utilization to yield cost-effective, quality outcomes that are patient-centric and safe. Overall, improves transition of care, quality reporting, patient satisfaction, as well as patient and family engagement to prepare for population health.
Previously Selected Hospitals May Re-apply In Alternating Years
• Previous participating hospitals may re-apply in alternating years for the consultation that was not previously supported, but will not be selected in consecutive years.◦ Hospitals participating in SRHT Project prior to 2017
– 2018 program year may submit an application for onsite TA that they have not received in the previous consultation.
• Hospitals that participated in the 2017-2018 program year are ineligible to submit an application for the 2018-2019.
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Download Application Questions To Prepare for the Open Application Period
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Submit Application and Self-assessment Online
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Online application form and online self-assessment will be made available on the release date.
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Submit A Full Application
• Full application contains 2 parts: an online application form and online self-assessment.
• All applicants (both CAHs and PPS hospitals) must answer all questions to submit a full application.
• An application is incomplete if either a section is missing, and/or information is missing within the application.
• An incomplete application will be returned and not scored.
• Re-submit a new online application and/or re-take the self-assessment immediately if the first application is considered incomplete.13
Helpful Hints To Submit A Successful Application
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• Do not leave any blanks as it will negatively impact your score, and possibly be considered as an incomplete application.
• Provide an explanation for all responses. Explain both Yes and No responses, even if the question specifies clarification for only ‘if yes’ or ‘if no’ answers.
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Selection Process Considers Hospitals that...
• Are willing and able to meet program requirements,readiness requirements, and project expectations
• Have no pending projects or anticipated issues that would hinder the TA process
• Have TA needs that are congruent with the SRHT Projects and available services
• Have implemented the consultant recommendations and demonstrated that no further performance improvement opportunities from previously supported SRHT Projects
• Are not currently supported with a SRHT-like Project
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Selected Hospitals Are Expected To…
Meet program requirements, readiness requirements, and project expectations by:• Meeting program timelines and deadlines• Implementing consultant recommended best practices • Adopting consultant recommended transition to value
strategies • Completing post-project follow up activities• Reporting post-project values• Participating in the SRHT Learning Collaborative
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Consultation Process and Learning Collaborative
I. Pre-onsite Planning
II. First Onsite Consultation: Interviews
III. Prepare for Second Onsite Consultation
IV. Second Onsite Consultation: Report
Presentation and Action Planning
V. Implementation of Action Plan
VI. Post-project Follow-up
VII. Participate in a Learning Collaborative17
SRHT Hospital Learning Collaborative Purpose and Objectives
• Develop a Strategy Map and Balanced Scorecard • Develop metrics to drive performance • Apply best practice tools from the Rural Hospital
Toolkit to:◦ Support the implementation of consultant
recommendations◦ Operationalize transition strategies developed
within the strategy map
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Post-Project Follow-up Activities
• Monitor progress towards performance goals
• Modify plans to better direct action steps
• Demonstrate measurable outcomes
• Determine project impact
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Source: Institute for Healthcare Improvement
Download Handouts To Learn More
• SRHT Work Plan and Consultation Process -Outlines the hospital’s FOA and QI project work plan, discusses who should be involved, and defines the methodology
• SRHT Post-Project Tracking and Reporting - Outlines the post-project process and reporting requirements for demonstrating measurable outcomes
• SRHT Consultation Process and Estimated Time Requirements - Estimates the time required for hospital teams to complete program activities
Hospital Work Plans
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SRHT Hospital Project Outcomes (2016 - 2017)
Three hospitals completed FOA. Two of FOA hospitals that reported:
• Increase in net patient revenue by 7% and 17%
• Increase in net income by 18% and one nearly doubled
• Increase in days cash on hand by 14 and 10 days
• Increased patient satisfaction scores for “patients who gave their hospital a rating of 9 or 10”
◦ 78% to 100%
◦ 77% to 84%
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SRHT Hospital Project Outcomes (2016 - 2017)
Six hospitals completed QI Projects: 4 CAHS and 2 PPS.
Of the four CAHs, three reported:
• Two increased Emergency Department Transfer Communication (EDTC) from 76% to 100% and 89% to 94%, and one maintained high score of 93%
• Two increased HCAHPS discharge planning scores from 76% to 100% and 90% to 91%, and one showed slight decreased from 90% to 88%
• One increased HCAHPS transitions of care scores from 42% to 49% and two experienced in slight decrease from 59% to 58% and 56% to 53%
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SRHT Hospital Project Outcomes (2016 - 2017)
Six hospitals completed QI Projects: 4 CAHS and 2 PPS
Of the two PPS hospitals that reported:
• One increased HCAHPS discharge planning scores from 86% to 95%
• One maintained high HCAHPS discharge planning score of 90%
• Both increased HCAHPS transitions of care scores:
◦ 41% to 43%
◦ 48% to 55%
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SRHT Hospital Project Outcomes (2015 - 2016)
Six FOA hospitals, on average, increased:
• Net income by 6%
• Days cash on hand by 16 days
• Patient satisfaction scores from:
o 59% to 71% for “patients who gave their hospital a rating of 9 or 10”
o 62% to 68% for “patients who would definitely recommend the hospital”
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SRHT Hospital Project Outcomes (2014 - 2015)
Of the four FOA hospitals:• Three increased net patient revenue by 11%• Two increased days cash on hand by 11 days
Of three QI hospitals:• Two decreased total readmissions rate from
15.8% to 11.5%, on average• Three increased HCAHPS discharge planning
scores from 46.4% to 62.3%, on average
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Refer To SRHT Project Hospital Spotlights For Benefits of Participation
• Russell County Hospital Aligning for Future Success• Marcum & Wallace Memorial Hospital Successfully Impacts
Project Outcomes• Chicot Memorial Medical Center Utilizes SRHT Project to
Prepare for the Future• Union General Hospital "It's a Girl Thing: Making Proud
Choices"• North Sunflower Medical Center Successfully Addressing
Chronic Care Management• Spotlight on Tallahatchie General Hospital
SRHT Project Hospital Spotlights
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The Rural Hospital Toolkit
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Rural Hospital Toolkit
Delta Region Community Health systems Development (DRCHSD) Program
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Delta Region Community Health System Development (DRCHSD) Program Supported By:
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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U65RH31261, Delta Region Health Systems Development, $2,000,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
DRCHSD Program Purpose and Goals
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Technical Assistance Approach
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Consultations and services are phased-in over three years
Delta Memorial Hospital (DMH): Preparing for Population Health
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www.deltamem.org
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DMH Vision and Mission
• Our vision is to create a model of excellence in quality healthcare delivery.
• Our mission to promote the healing and wellness for residents of the Southeast Delta Region in a courteous and competent manner.
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DMH Primary Service Area
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Desha County, ArkansasDemographics
• Population: 11,764• Median per capita income of $17,324• 18.4% ≥ 65 years of age• 16% < 65 years of age with a disability• 26.5% poverty• Payor mix:
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Overall Rankings in Health Outcomes
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Overall Rankings in Health Factors
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DMH Participation In Rural Health Programs
• Initiated in 2018, now participating in Delta Region Community Health Systems Development (DRCHSD) Program
• SRHT Quality Improvement (QI) Project in 2017• Rural Hospital Performance Improvement (RHPI)
Financial Operational Assessment (FOA) Projects in 2008 and 2012
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SHRT Timeline
• January 4, 2017 – SHRT Kick-off call• February 14, 2017 – data request due• March 7, 2017 – First onsite consultation:
interviews• April 11, 2017 – Second onsite visit; presentation
of findings and recommendations• October 10, 2017 – 1st Recommendation Adoption
Progress (RAP) call at 6 months• April 30, 2018 – 2nd RAP at 12 months
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DMH Pre-Project Values
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DMH Quality Improvement Action Plan
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Next Steps…
• Obtain CPSI access for home health office staff• Decrease patient survey size- eliminate questions
that are not required• Establish a standardized process for patients
coming in for tests• Begin monthly reporting of process improvement
reports and continue with quarterly quality meetings
• Implement Chronic Care Management Program
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Service Excellence Advisor Leaders (SEAL Team)
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SEAL TeamImproved Post-discharge Activities
• Follow-up on post-discharge phone calls◦ Developed a script to use when calling patients
to ensure specific areas are addressed◦ Calls are completed 48-72 hours post
discharge◦ Part of PI plan for Nursing management
• Created Discharge Binders for inpatients◦ Given to patients on admission
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SEAL TeamEnhances Transitions of Care (TOC)
• TOC includes: ◦ Area provider and pharmacy lists◦ HIPAA disclaimer◦ DMH mission statement◦ Admission booklet◦ Patient rights and responsibilities◦ Patient satisfaction flyer◦ TV guide, test results, prescriptions, ◦ Discharge summary and appointments◦ Patient education
• Patients carry discharge binders to follow- up appointments, specialists, etc.
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SEAL TeamPerforms Daily Leadership Rounds
• Developed monthly leadership rounding calendar for management
• Employee rounds (Internal Customers)◦ Department are rounded on weekly◦ Addresses any staff needs/issues/concerns that may
impact their ability to perform their job duties◦ Opens communication between staff and management
• Patient rounds (External Customers)◦ Patients are rounded on daily◦ Addresses any patient care needs/issues/questions◦ Ensures patient safety and rooms are appropriately
equipped
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Department Rounding Log
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Patient Rounding Log
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49
50
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SEAL TeamDeveloped Organizational Wide Staff Trainings
• Customer Service Training ◦ Monthly in-service trainings at Department manager
meetings◦ Materials given to managers and are incorporated
into monthly department in-services• Patient survey education with monthly report cards◦ Includes new hire orientation and annual all
employee training◦ Monthly report cards reviewed at monthly PI,
executive team, medical staff, and board meetings◦ Distributed to all employees and posted in
departments
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EMERGENCY DEPARTMENT 1st QTR REPORT
Dimension: 2nd qtr 2018 (8)
1st Qtr (35)
4th Qtr (23)
3rd Qtr (30)
2nd qtr (37
1st qtr 2017 (27)
DMH Ave
AR Ave
Cleanliness/Quietness 88 80 87 76 70 86 78 83
Comm with Providers 89 82 87 93 76 89 84 78
Comm with Nurses 88 80 81 79 70 91 78 81
Would Recommend 86 72 69 71 49 67 59 69
Pain Management 67 46 54 70 39 75 55 59
Overall Rating 75 40 65 47 33 70 49 51
Discharge Info 60 46 62 49 43 74 53 60
HCAHPS – ADULT INPATIENT #2 #15 8 #8 #13 #24
Responsiveness of Staff 50 63 86 68 60 75 69 69
Communication with Drs 100 91 84 70 77 94 81 83
Cleanliness/Quietness 75 70 82 72 62 73 73 70
Discharge Info 100 100 79 66 82 80 76 86
Communication re: Meds 100 75 75 43 100 50 54 67
Communication Nurses 100 69 71 66 70 84 74 81
Communication on Pain ‐‐‐ 65 New question
Care Transitions 100 56 59 33 44 49 42 54
Would Recommend 100 74 58 53 62 60 56 79
Overall 100 40 25 34 39 48 39 60
OUTPATIENT TESTING #12 #62 #78 #58 #65 #45
Cleanliness/Quietness 84 78 85 85 77 80 81 87
Overall Rating 59 47 63 51 48 53 52 57
Would Recommend 73 61 75 70 62 69 64 76
OUTPATIENT SURGERY #5 #3 #3 #0 #3 #4
Discharge Info 63 84 100 No surveys 84 75 82 80
Responsiveness 100 100 100 100 75 100 86
Would Recommend 80 100 100 100 100 100 90
Communication with Drs. 100 100 89 100 100 96 89
Communication – nurses 94 100 89 100 100 96 88
Overall Rating 60 67 67 67 50 63 75
Cleanliness/Quietness 100 100 34 100 100 75 90
OUTPATIENT REHAB #0 #0 #11 #10 #5 #6 E. Central US
Cleanliness/Quietness none none 70 70 100 84 76 94
Pain Management 90 88 75 84 88 82
Responsiveness 100 88 75 100 90 93
Overall Rating 55 30 75 50 44 68
Would Recommend 73 60 80 100 80 91
HOME HEALTH #3 #5 # 12 #7 #13 #13
Would Recommend 100 88 91 100 84 73 86 86
Care of the Patient 100 85 96 94 94 95 91 92
Provider Communication 100 91 90 100 88 76 84 90
Specific Care Issues 86 93 84 96 94 79 89 88
Overall Rating 100 88 73 75 50 60 57 76 52
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Discharge +/‐ Comment
EMERGENCY DEPARTMENT
03/16 Living in a Small town, I feel that we are extremely lucky to have a hospital and staff of this caliber!
04/02 Staff was wonderful!
04/12 They all done a great job. A lot better than in the past.
04/18 Excellent care!
HCAHPS – Adult Inpatient
04/16 Doctors and staff went above and beyond in the care of this patient!!!. They tried everything they could to save my sister.
OUTPATIENT TESTING
2/19 Dr. Chambers and his staff always take good care of me.
3/22 1. Outstanding staff. 2. Dr. Chambers –outstanding. 3. Facility needs maintenance in restroom – water leaks and dirty.
4/17 Everybody that has helped me in the past and up till not has been very nice and helpful and considerate. Thank You!
5/11 Thank God for you all!
OUTPATIENT SURGERY—No new comments
OUTPATIENT REHAB ‐ no new comments
HOME HEALTH
04/01 They were great
04/01 Yes, this agency is in my opinion, #1. For me they are excellent.
05/01 They have all been very nice and easy to talk to.
RESPONSE RATES: 1st qtr, 2018
SURVEY SAMPLED NON‐DELIVERABLE
RETURNED RESPONSE RATE %
4th qtr %
3rd qtr %
2nd qtr %
Emergency Dept 421 28 32 8 8 8 9
HCAHPS 149 4 15 11 14 8
OP Tests 502 7 56 12 20 13 16
OP Surg 14 0 3 22 13 0 15
OP Rehab 3 0 0 0 38 22 21
Home Health 43 2 8 20 17 14 26
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SEAL TeamImplemented an Employee Recognition Program
• DMH “STAR” employee of the month• Staff are nominated by both employees and patients• SEAL team chooses from the nominees• Each STAR is recognized with:◦ Their picture and bio on the DMH communication
board◦ An article in the DMH newsletter and local
newspaper. • Each STAR receives a certificate of appreciation and
gift certificate for free meals
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DMH Post-Project Values and Outcomes
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SEAL Team is currently working …
• On medication cards for the 20 most common medications prescribed and DMH
• On wording in layman terms the reason for the medication and potential side effects
• To decrease the amount of discharge information given to patients at discharge. ◦ Only give the patients the pertinent
information
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DMH Next Steps…
• Delta Regional Community Health Systems Development (DRCHSD) Program
o Quality Improvement assessment
o Financial Operational assessment
o Population Health Planning
o Community Care Coordination
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To Learn More About DMHProcess Improvements and Outcomes
• Delta Memorial Hospital’s SEAL Team, May 2018
• Delta Memorial Hospital: SRHT Project Well Under Way, Nov. 2017
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Questions
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Let Us Be Your Resource Center
www.ruralcenter.org60
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Get to know us better:http://www.ruralcenter.org
Contact Information
Ashley AnthonyChief Executive Officer
Delta Memorial Hospital
Bethany AdamsSenior Program Manager
National Rural Health Resource Center
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Speaker Bio: Ashley Anthony
Ashley Anthony, BSN, RNChief Executive OfficerDelta Memorial Hospital
In 2016, Ashley accepted the position of Chief Executive Officer at Delta Memorial Hospital (DMH), a 25-bed CAH located in Dumas, Arkansas. She has served in various positions at DMH for over the last 11 years. Her vision for DMH is to create a model of excellence in quality healthcare delivery and develop innovative programs and services to benefit patients and enhance the overall quality of life in Dumas, Arkansas and surrounding communities. Ashley graduated from the University of Arkansas at Monticello with Bachelor of Science in Nursing in 2005 and has worked in all areas of the hospital nursing setting to include case management, quality and administration. Previously, Ashley has held the position of Quality Specialist for Arkansas Foundation for Medical Care where she served providers in the Delta Region. She also serves on the Board for the Arkansas Rural Health Partnership (ARHP) and the Board for the Arkansas Medicaid Quality Improvement program. Ashley is married to husband Rick Anthony and have four children (three boys and one girl) and a one dog.
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Bethany has over fifteen years of experience in rural health and serves as Program Manager for the SRHT project, and previously managed the Rural Hospital Performance Improvement project. Bethany served as the Assistant Program Manager for the KY Rural Health Works Program, and worked for the KY State Office of Rural Health as a Program Coordinator. Bethany holds a double Bachelor of Science in Clinical Laboratory Science and Biology from the University of KY. She also obtained a Master of Health Administration from the University of KY and is a fellow with the American College of Healthcare Executives.
Speaker Bio: Bethany Adams
Bethany Adams, MHA, FACHESenior Program Manager
National Rural Health Resource Center
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