HEALTH CARE FINANCING ADMINISTRATION OFFICE OF ACQUISITION AND GRANTS, 2-21-15 CENTRAL BLDG. 7500 SECURITY BLVD. BALTIMORE, MD 21244-1850

A -- EVALUATION OF THE RURAL HEALTH CARE TRANSITION GRANTS FOR FY 1995 SOL HCFA-95-050/DB POC DAVE BARBATO, CONTRACT SPECIALIST, 410-786-5145. A. Individual Project Evaluation The individual project evaluation will provide HCFA with an ongoing profile of individual hospitals that received FY 1995 awards and their progress in planning and/or implementing the components of their projects, and provide data and information for use in evaluating the overall impact of the grants. 1. Hospital Status Reports Hospital status reports shall be submitted to HCFA, through the contractor, by all hospitals receiving an award. These reports shall be submitted to the contractor by participating hospitals every 12 months and will provide HCFA with baseline information, information on the project's progress, and information on grant expenditures. Data collected by the contractor shall be used to establish a baseline that provides a detailed overview of the hospital's characteristics and trends, characteristics of the hospital's market/service area, and the service population demographics. Data collected through the demonstration period shall be used to update the baseline and include elements that address the issues and hypotheses identified in the evaluation design. Baseline indicators will also be used to clearly demonstrate the hospital's progress, and success or failure in planning and/or implementing the components of its program. This data will supplement the hospital's statements concerning its progress in the project activities section of the report. Data on the use of grant funds shall also be collected that includes documentation to support expenditure reports, i.e., receipts, etc. The format for these reports has already been developed and has been in use since the first awards under this program were made in FY 1989. The baseline information uses a format that utilizes existing data being reported to HCFA by the hospitals, so it is not burdensome to the hospitals. The format for the project activities and progress reports, and grant expenditures is provided as part of the Reference Material. The contractor will provide technical assistance to grantees by phone, should assistance be required in completing the interim reports. The contractor shall also follow up on reports that are late in being submitted by hospitals to expedite their submission. The contractor will also follow up on incomplete reports or reports submitted without sufficient documentation to ensure that comprehensive and accurate information is obtained. Additionally, the contractor will target subjects of particular interest to the evaluation or that are indicative of problems with the hospitals' progress with their projects. The contractor will follow up on these reports by telephone, and explore on a deeper level than the hospital status reports allow, the underlying causes and the effects upon the project and its impact upon the hospital and community. The contractor will prepare a composite summary of these reports as part of the required annual report to Congress, which is further elaborated upon in the section of the scope of work entitled Reports, Item D. 2. Case Studies The purpose of site visits is to gather detailed information on the health care environment of the community, assess the financial and managerial viability of the hospital, assess whether the project is being implemented as described in the hospital's proposal and reports, audit the use of grant funds, and measure the impact of the grant project on the hospital and the community. Sites will be selected to target hospitals that distinguish themselves in some positive or negative way from the entire group chosen for the grant. Potential problems for hospitals could include those affecting financial and/or managerial viability, the threat of closure and limiting access to care. A hospital that has developed projects with the potential to have a significant and measurable impact on improving its situation would be appropriate for site visits. We have projected that site visits to approximately 10 percent of the hospitals throughout the three years will be sufficient. The sample might also be stratified according to project type and geographic location. The contractor will develop a sampling strategy that will suggest the criteria to be used in selecting sites, the data elements to be collected, and the sources of the data and the techniques for data collection and verification. The project officer will have final approval of selection criteria and sites to be visited. The contractor shall develop a design that is cost-effective in allowing for the most in-depth analysis for the amount of money spent. These case studies will be incorporated by the contractor as part of the annual reports to Congress. B. Overall Impact of RHCTG These grants are intended to strengthen the financial and managerial capability of the hospitals. The contractor shall evaluate the overall success or failure of these grants in accomplishing these goals. The contractor shall also consider the value and practicability of reviewing progress of previous grantees' status to inform the evaluation. This evaluation shall result in recommendations, clearly supported by the findings, as to how rural hospitals nationwide can improve their financial and managerial capability, and the most effective means for the Federal Government to support these efforts, The tasks to be completed by the contractor in the evaluation are the following: 1. The contractor shall prepare and submit to the project officer for approval, a proposed evaluation design that is a rigorous analysis that will consider the planning, process/development, operations and outcome of the RHCTG and shall implement this design upon the approval of the HCFA project officer. Specifically, the factors to be analyzed include the following: a. Planning, Process/Development 1) The hospitals' financial and managerial performances and trends prior to receipt of the award, i.e., 2 years prior trends. 2) The type of analyses the hospitals have done prior to the selection of the factors to be adjusted for and the results and recommendations of the analyses by the hospitals. 3) The reasons and decision process involved in selecting the problems to be addressed through the grant. b. Operationalization 1) The factors that affected the development and/or implementation of the project, predicted and actual barriers to implementation and methods for overcoming them, and predicted and actual factors that facilitated implementation of the plan and the operations. 2) The financial impact of the grants on participating hospitals, i.e., start-up costs, operating revenues, and operating costs, as well as variations among hospitals by location, size, and type of project. c. Outcome 1) The direct effects of the grants on the financial and managerial capabilities of the participating hospitals. 2) Assessment of how effectively hospitals, through their use of the grants, have dealt with the issues that are common to rural hospitals, i.e.: a) changes in clinical practice patterns, b) changes in service populations, c) declining demand for acute care inpatient hospital capacity, d) declining ability to provide appropriate staffing for inpatient hospitals, e) increasing demand for ambulatory and emergency services, f) increasing demand for appropriate integration of community health services, and g) the need for appropriate access (including appropriate transportation) to emergency care and inpatient care in areas in which a significant number of underutilized hospitals are being eliminated. 3) The indirect effects of the projects, e.g., impact on other community providers, and the perception of community members about the impact of the project. 4) Assessment of whether the project met the expectations of the participants and consideration of methods for improving the demonstration program. 5) Generalizability of the evaluation results across various hospital settings and environments, identification of the variables related to the success or failure of the project chosen by the hospital, and consideration of whether certain conditions and processes increase the likelihood of success of the project. The contractor should provide an overview of the relationships among evaluation issues, methodologies, and data sources. In developing an evaluation design, the contractor shall specify the evaluation components, the data sources to be used for each component, the methodology for analysis, and the objective of the analysis. 2. Consultation The contractor shall be available for telephone consultation to provide technical assistance to the hospitals implementing these grants on issues which relate to the coordination of the demonstration and evaluation design issues, and their submission of hospital status reports. 3. Routine Meetings The contractor shall meet with the project officer on a routine basis as needed (and at least quarterly) to discuss technical issues, progress in monitoring and evaluation objectives, existing or potential problems, etc. The contractor shall submit a summary report of the discussions reached at each meeting, to be reviewed and approved by the project officer. (0132)

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