The
Health Resources and Services Administration
(HRSA) is the principal Federal agency
within the Department of Health and
Human Services (DHHS) charged with increasing
access to basic health services for
the nation’s underserved, vulnerable,
and special needs populations. With
a budget of over $6 billion, HRSA provides
direct financial assistance, in the
form of grants or cooperative agreements,
to over 3,000 organizations (i.e., grantees)
for the purpose of carrying out 80 different
programs that improve and expand access
to quality health care and reduce disparities
in health status.
To
assure that all HRSA funded programs
are accomplishing their intended purposes,
HRSA continuously tracks and analyzes
the performance of its grantees. In
1993, the Government Performance and
Results Act (GPRA) reinforced these
agency-wide efforts by requiring all
Federal agencies to submit annual reports
on program performance. Agency program
performance reports describe the actual
program performance achieved, compared
with the performance goals expressed
in the agency’s performance plan.
For
HRSA, seven strategic goals serve as
the organizing framework for the agency’s
program performance measures:
-
Improve Access to Health Care
-
Improve Health Outcomes
-
Improve the Quality of Health Care
-
Eliminate Health Disparities
-
Improve the Public Health and Health
Care Systems
-
Enhance the Ability of the Health
Care System to Respond to Public Health
Emergencies
-
Achieve Excellence in Management Practices
Role
of the Office of Performance Review
The Office of Performance Review (OPR)
plays a central role in achieving the
HRSA mission and its program performance
goals. With a headquarters office in
Rockville, Maryland; ten regional divisions
in Boston, New York, Philadelphia, Atlanta,
Chicago, Dallas, Kansas City, Denver,
San Francisco, and Seattle; as well
as a sub-regional office in Puerto Rico,
OPR serves as the agency’s focal
point for reviewing and enhancing the
performance of HRSA funded programs
within communities and States. On a
regularly scheduled basis, HRSA grantees
are reviewed by a team from one of the
ten OPR regional divisions.
Purpose
of Performance Reviews
The purpose of performance reviews is
to improve the performance of HRSA funded
programs. All HRSA grant programs (including
cooperative agreements) eligible for
a review are designated by OPR as either
a Category 1 or Category 2 grant program
for the purpose of conducting a performance
review.
-
Category 1 includes: health services
delivery activities and professional
training programs with measurable
data.
-
Category 2 includes: grant programs
funding professional training and
public health infrastructure development
that do not lend themselves to using
the same approach used for Category
1 grant programs typically due to
small numbers of recipients/clients,
limited term funding, or the scope
of the activity.
Through systematic pre-site and on-site
analysis using the Performance Review
Protocol, OPR works collaboratively
with grantees and HRSA Bureaus/Offices
to assess the performance of HRSA
funded programs. The review of Category
1 grant programs measures program
performance, analyzes the factors
impacting performance, and identifies
effective strategies and partnerships
to improve program performance. The
review of Category 2 grant programs
analyzes the factors impacting the
ability of the grantee to meet selected
goals and objectives of the grant
program and/or achieving sustainability
beyond the end of HRSA support, and
identifies effective strategies and
partnerships to improve performance/progress
on program goals and objectives. Performance
reviews also provide direct feedback
to the agency about the impact of
HRSA policies on program implementation
and performance within communities
and States. From this analysis and
feedback, OPR tracks key program performance
issues, identifies effective practices
and outstanding program outcomes,
provides technical assistance, and,
when appropriate, develops recommendations
for changes to HRSA policies to further
enhance the performance of HRSA funded
programs.
Performance
Review Protocol
The Performance Review Protocol is a
performance improvement tool used with
each grantee to review its HRSA funded
programs. When a grantee receives more
than one HRSA grant, the grantee’s
HRSA funded programs selected for review
are optimally reviewed during the same
onsite visit. In cases where it is not
possible to schedule reviews of all
the grants during one onsite visit,
separate reports of the individual reviews
may be issued. In such cases, each of
the performance review reports will
provide standard background information
on the grantee organization, a description
of all HRSA grants received by the grantee,
a description of the grant programs
being reviewed, and specific information
on the scope of the report.
For
Category 1 grant programs, the four
primary components of the protocol are:
-
Performance Review Measures
- Performance
Analysis and Key Area Discussion
-
Performance Report
-
Action Plan/Technical Assistance/Follow-up
For
Category 2 grant programs, the four
primary components of the protocol are:
-
Goals and Objectives
-
Discussion about Progress/Impact/Sustainability
- Performance
Report
-
Action Plan/Technical Assistance/Follow-up
I. Review of Category 1 Grant Programs
A.
Performance Review Measures
Effective performance measures describe
the population served by each program,
the level and scope of program services
or resources provided to this population,
how well the program is providing those
services or resources, and the impact
of the services or resources on the
population served. The most important
types of performance measures for a
program or set of programs are: (1)
outcome measures (i.e., measures
that track the impact or effectiveness
of a program or set of programs); and
(2) effort measures
(i.e., measures that assess the grantee’s
efforts to implement a program or set
of programs).
Performance
reviews begin with a pre-site review
of established program performance measures
(i.e., HRSA GPRA measures http://www.hrsa.gov/perplan,
and HRSA program performance reporting
requirements) and the grantee’s
program goals and objectives as identified
in their grant application(s). From
this pool of established measures, the
review team, in collaboration with the
grantee and through consultation with
the HRSA project officer(s) and other
appropriate HRSA staff, selects a set
of Performance Review Measures for each
funded program. These measures define
the scope and focus of the performance
review.
Selection
of Performance Review Measures
For
each funded program:
- Does
the grant have specific program measures?
-
What are the grant’s goals and
objectives?
-
Who is the population served (e.g.,
patients, students, customers)?
- What
are the specific services or resources
provided to this population?
-
From the pool of measures, what are
the key outcome and effort measures?
-
Are these measures of outcomes
and efforts communicated easily?
-
Do they measure the most important
outcomes and efforts?
-
Is the data available and credible?
Once
the Performance Review Measures are
selected for each grant, the review
team, in collaboration with the grantee
and the HRSA project officer(s) and
other appropriate HRSA staff, determines
performance achieved on each measure.
Progress is assessed by comparing actual
performance with established HRSA program
and/or grantee performance goals.
Progress
on Performance Review Measures
-
How is the grantee performing on each
Performance Review Measure?
-
What are the grantee’s performance
trends for each measure?
- What
is the gap from current to desired
performance on each measure?
B. Performance Analysis and
Key Area Discussion
After
the Performance Review Measures have
been selected and data has been collected
and graphed, the Performance Analysis
portion of the review examines the factors
contributing to and restricting the
grantee’s performance on the selected
measures. The analysis and discussion
for a grant includes reviewing the grantee’s
internal systems and processes, external
issues (including HRSA policies and
environmental, political, demographic,
and economic trends) that may contribute
to or restrict the grantee’s performance
on the Performance Review Measures,
and the grantee’s successes or
challenges in forming and sustaining
successful performance partnerships.
Starting
with a pre-site visit review of the
grantee’s program applications,
progress and data reports, and applicable
HRSA program guidance/expectations (http://www.hrsa.gov/grants/preview),
the review team, in collaboration with
the grantee and through consultation
with the HRSA project officer(s) and
other appropriate HRSA staff, analyzes
the following performance factors for
each performance review measure through
its pre-site and on-site work.
Performance
Analysis and Key Area Discussion
- What
are the key factors behind the grantee’s
performance on each selected Performance
Review Measure?
-
How do the grantee’s internal
systems and processes contribute
to or restrict the grantee’s
performance on each measure? (See
Appendix A)
- What
external issues, including HRSA
policies, are influencing the
grantee’s performance on
each measure?
-
What are the grantee’s successes
and challenges in forming and
sustaining partnerships that support
its performance on each measure?
-
What is the order of priority among
the factors examined – which
are the most important to address
to improve the grantee’s performance
on each measure?
-
What additional information about
the grantee and its implementation
of the grant program enhances an understanding
of the challenges and opportunities
the grantee faces in achieving its
mission?
-
What significant accomplishments and/or
best/promising practices should be
highlighted?
II.
Review of Category 2 Grant Programs
A.
Goals and Objectives
A
performance review of a Category 2 grant
program begins with a pre-site visit
examination of a grantee’s goals
and objectives as described in its application.
From this set of goals and objectives,
the review team in collaboration with
the grantee and HRSA project officer(s)
and other appropriate HRSA staff, selects
a set of three to five significant goals
and objectives on which to focus. The
grantee’s goals and objectives
should be aligned with HRSA grant program
goals and objectives. If the grantee
has sufficient and reliable data regarding
their pursuit of a goal or objective,
the review team should present it as
an indicator of progress towards a goal
or objective.
Identification of Goals and
Objectives
For
each funded program:
-
What are HRSA’s stated goals
and objectives for the grant program?
- What
are the grantee’s stated goals
and objectives in the grant application?
-
Who is the population served (e.g.,
patients, students, consumers)?
-
What are the specific services or
resources provided to this population?
B. Discussion about Progress/Impact/Sustainability
After
goals and objectives have been selected,
the review team and the grantee conduct
an on-site facilitated discussion regarding
the progress the grantee has made in
achieving the selected goals and objectives.
Issues to consider are factors contributing
and restricting attainment of the selected
goals and objectives, the grantee’s
impact on its target population/community,
the structure and functioning of the
grantee’s internal systems, and
external issues (including HRSA policies,
and environmental, political, demographic,
and economic trends) which may affect
performance. If applicable, the discussion
should identify the grantee’s
plans and efforts to sustain its project
after support ends. The grantee also
may share lessons learned in implementing
its project and best or promising practices
that may be beneficial to other similar
grantees.
Performance Analysis and Key
Area Discussion
- What
are the key factors behind the grantee’s
performance on selected goals and
objectives?
-
How do the grantee’s internal
systems and processes contribute
to or restrict the grantee’s
performance? (See Appendix A)
- What
external issues, including HRSA
policies, influence the grantee’s
performance?
- What
are the grantee’s successes
and challenges in forming and
sustaining partnerships that support
its performance?
-
What additional information about
the grantee and its implementation
of the grant program enhances an understanding
of the challenges and opportunities
the grantee faces in achieving its
goals and objectives?
-
What significant accomplishments and/or
best/promising practices should be
highlighted?
III.
Additional Considerations for Subsequent
Reviews
Performance
reviews of grantee organizations may
include grants that have been reviewed
during previous reviews. In those situations,
OPR will want to report on the grantee’s
development and performance improvement
since the prior review. This focus will
be included as part of the pre-site
review and on-site analysis.
While
subsequent reviews will include an analysis
of the grantee’s progress on the
prior review’s performance measures
(as outlined below), the selection of
performance measures should be guided
by how to best assess the grantee’s
current performance, as well as established
standards and measures by the Bureaus
and Offices. The use of the performance
measures from the previous review may
not be appropriate, and is not a requirement.
A complete set of new measures may be
selected, a couple of the prior measures
may be used with a few new measures,
or a complete reuse of the prior measures
may be appropriate. The selection of
measures should be in keeping with current
OPR requirements, in terms of the number
of measures selected, the use of Bureau-approved
measures, and working in collaboration
with the project officer and grantee.
A.
Pre-Site
Review teams should refer to the performance
report and action plan from the grantee’s
prior performance review, and debrief
with the previous review team when appropriate.
The team’s pre-site discussions
with the grantee and project officer
should then include an update on the
grantee’s efforts to improve its
performance.
Assessment
of Organizational Development and Performance
Improvement
- How
has the grantee’s structure
and capacity changed since the prior
review?
- How
have the demographic characteristics
and needs of the service area or target
population changed since the prior
review?
- How
have the health care environment and
marketplace changed since the prior
review? How has that impacted the
grantee in terms of potential competition
and potential partnerships? Has the
strategic plan been updated, and if
so, when?
- How
has the grantee used the prior performance
review to improve performance, increase
access, and/or reduce health disparities?
- Has
the grantee implemented the action
plan items from the prior review?
What has been the impact?
- If
the grantee received technical
assistance following the prior
review, was it helpful? How so?
- Has
the grantee continued to track
the performance measures from
the prior review? If so, has the
grantee made progress on those
measures? If the grantee has not
continued to track the performance
measures from the prior review,
what were the factors in not doing
so?
- Have
there been organizational leadership
changes (management team, governing
board, or key staff) since the prior
review? What has been the impact?
B. On-Site
During the on-site phase of the current
performance review, issues may arise
that parallel or expand upon the factors
from the prior review. In those instances,
the team will note the similarities,
and record them as a key area discussion,
when appropriate.
Performance
Analysis and Key Area Discussion
-
Are there restricting factors that
were documented during the prior review,
which are still barriers to delivering
services or programs effectively?
-
If there have been significant changes
in structure, capacity, or leadership,
how have they impacted the grantee’s
service or program delivery?
-
Was a potential leading practice identified
in the prior review? If so, what are
the outcomes of the practice to date,
and should it be formally reported?
-
Has the grantee implemented any new
strategic plans or priorities to address
any of the contributing or restricting
factors that were identified in the
previous review?
IV. Performance Report
Upon
completing the analysis of the factors
impacting the grantee’s performance
on each of the Performance Measures
and/or its achievement of program goals
and objectives, the review team, working
on-site with the grantee, develops a
preliminary set of Performance Improvement
Options and Actions that the grantee
can include in the Action Plan to improve
performance. The review team assists
the grantee in identifying evidence-based
strategies, no-cost/low-cost options,
as well as partners who may have a role
to play in improving the grantee’s
program performance.
After
the on-site portion of the performance
review is completed, the review team
presents its findings, including any
identified Program Requirement issues,
in a draft Performance Report, and requests
feedback on the report from the grantee,
HRSA project officer(s), and other appropriate
HRSA staff. The review team reviews
the feedback received and develops the
final Performance Report.
Performance
Report
-
Executive Summary describes the grantee
organization, HRSA grants received
and reviewed, key findings of the
performance review, and special accomplishments
(not to exceed 2 pages).
- Table
of Contents lists six major sections
and parts of Section IV, Grantee Performance
-
Grantee Information provides grantee
contact information.
- HRSA
Grant Program Information identifies
HRSA grants received.
- Grantee
Overview describes the grantee organization;
the HRSA grants received and reviewed,
the scope of the report, population
served, and the services/ resources
provided by the HRSA funded program(s)
reviewed.
- Performance
Measures and/or Goals and Objectives
present trend data on each of the
selected Performance Review Measures
and/or Program Goals and Objectives.
A graph and trend analysis is required
for review of Category 1 grants
-
Performance Analysis and Key Area
Discussion summarizes the factors
(including HRSA policies) contributing
to and restricting the grantee’s
performance with respect to each measure
and/or impacting the grantee’s
ability to achieve program goals and
objectives. The discussion of the
broader key areas that are not directly
aligned to performance measures should
also be captured in this section,
as well as promising practices.
-
Performance Improvement Options provides
options to improve performance with
respect to each measure and/or program
goal or objective, and, when necessary,
identifies technical assistance needs.
Options include: evidence-based strategies,
no-cost/low-cost options, as well
as forming partnerships with those
who may have a role to play in improving
program performance.
-
Program Requirements identifies, when
necessary, a requirement of applicable
program statutes, regulations, and/or
grant award conditions.
- For
Subsequent Reviews, the review team
will note the date of the prior review
in the Executive Summary and in the
Grantee Overview. General observations
about the grantee’s performance
improvement since the prior review
and other ways in which the prior
review achieved impact should be documented
in the Grantee Overview, and specific
observations that relate to a particular
performance measure can be recorded
in a Key Area Discussion.
V.
Action Plan/Technical Assistance/Follow-up
If
the project officer was not part of
the on-site review team, the on-site
visit is followed by a call to debrief
the project officer(s) and a subsequent
three-way conference call among the
review team, the project officer(s),
and the grantee to discuss the development
of an Action Plan. Within the Action
Plan, the grantee is asked to describe
the specific actions to be completed,
and when necessary, to describe the
specific actions to be completed to
address any identified Program Requirement
issues. The grantee submits the draft
Action Plan, along with the grantee’s
feedback on the draft Performance Report,
to the review team. The review team
and project officer(s) provide feedback
on the alignment, specificity, feasibility
and potential impact of the actions,
and offer recommendations on any follow
up technical assistance that may be
appropriate. The grantee will finalize
the Action Plan based upon this feedback
and send the Action Plan to the review
team and project officer. The review
team will share the final Performance
Report with the grantee and project
officer. The performance review concludes
with the adoption of an agreed upon
Action Plan to be implemented and reviewed
by the grantee and the project officer
over time, as appropriate.
Action
Plan/Technical Assistance Request
- Action
Items describe the actions to be completed
by the grantee.
-
Key Steps specify where, how, who,
and by when each action will be accomplished.
- Technical
Assistance Request identifies, when
necessary, technical assistance to
support the grantee’s implementation
of the action plan.
VI. Sample Performance Review
Timeline
Week
1-8 Prior to the Site Visit: Review
of key grantee materials (i.e., grant
application(s), progress reports, program
guidance/expectations, and performance
data submissions.), consultation with
HRSA Project Officer(s) and other appropriate
HRSA staff, and discussions with the
grantee regarding measures or goals
and objectives and factors impacting
performance.
Week
9 Site Visit * (Note: Includes on-site
performance analysis, key area discussions,
and development of performance improvement
options. Review Team advises grantee
to begin drafting the Action Plan)
Week
13 Draft Performance Report sent to
Grantee with request for feedback and
an Action Plan. Feedback is also requested
from HRSA Project Officer(s) and Other
Appropriate HRSA Staff.
Week
15 The grantee sends feedback on the
draft Performance Report and submits
the draft Action Plan to the review
team and the Project Officer.
Week
18 Final Performance Report with approval
of Action Plan sent by OPR to grantee.
Final Performance Report and Action
Plan are distributed within HRSA for
Follow-up Actions/Technical Assistance
with grantee.
* The site visit is scheduled with the
Grantee at least 12 weeks in advance.
APPENDIX
A – Internal Grantee Systems and
Processes
Below
is a series of questions review teams
should consider when exploring factors
impacting performance and examining
the broader implications of the grantee’s
efforts on its overall performance.
Structure, Function, and Capacity
How does the grantee’s structure
and capacity support the HRSA funded
program, including subcontractor performance
and financial arrangements?
-
Is the management structure appropriate
for program implementation and performance,
including any governing board or planning
coalitions? Are there members on the
governing board or planning coalition
who are representative of the population
groups in the service area and are
knowledgeable of their health care
needs?
-
How does management assure that the
program is implemented in accordance
with stated program requirements,
including any grant award conditions?
-
Is there integration and coordination
of programs across the grantee?
-
Are there any emerging issues that
could impact on the grantee’s
capacity and/or structure (e.g. demographic,
economic, environmental shifts)?
Internal Quality Improvement (QI)
Program
-
Has the grantee implemented a QI program?
Throughout the organization?
- How
has the grantee used this QI program
to improve performance, increase access,
and work to reduce health disparities?
-
How does the QI program identify new
and emerging issues that need to be
addressed?
- How
and from whom is feedback obtained
and incorporated into the QI program?
- Has
the grantee undergone outside, independent
QI reviews (e.g., accreditation)?
How have the results of these outside
QI reviews been addressed?
Staff
Performance Systems
-
How are staff performance and productivity
reviewed?
- What
efforts are made to support staff
to improve outcomes and eliminate
health disparities (e.g., training
in cultural competency, access to
interpretation services, continuation
education, etc.)?
-
How are staff orientation and training
assessed?
Data Capacity and Systems
-
How does the grantee collect and analyze
data for tracking program performance
(including subcontractor performance)?
-
How does the grantee use their data
and information to support program
decision-making and innovation?
-
Does the grantee have the capability
to have changes made to their data
system to respond to new and emerging
changes to submission of required
data?
-
How does the grantee’s data
capacity support the timely submission
of reports required by HRSA and the
grantee?
- Has
the grantee invested in quality hardware
and software as well as staff to meet
their data needs?
-
Does the grantee have the capacity
to collect data by race, ethnicity,
and primary language?
-
Is there a process in place for building
consumer trust to facilitate the collection
of race/ethnic data?
Clinical Systems (For Grantees Involved
in Patient Care)
-
Does the grantee provide the required
and additional services necessary
(including referral arrangements and
after hours/weekend coverage) to achieve
program goals and objectives?
-
Does the grantee tailor services to
meet the needs of its consumers, including
those with limited reading skills,
with diverse cultural and ethnic backgrounds,
and who speak a primary language other
than English? How does the grantee
assure medical interpreter services
to these consumers?
-
How does the grantee assure that preventive
and emerging clinical care guidelines
are updated and followed
-
What quality assurance systems are
in place? What is the membership of
their Quality Assurance Committee?
What process does the QA Committee
use in selecting clinical performance
measures? How does the QA Committee
address the identified clinical issues
and deficiencies?
-
Does the grantee have clinical tracking
capability for referrals, ancillary
and laboratory results and no-shows?
- How
does the grantee assure patient confidentiality,
informed consent, and Human Subjects/IRB
protections where research is conducted?
How has the grantee implemented Health
Information Privacy Act (HIPAA) requirements?
-
What systems are in place to provide
for ongoing contact with patients
after the face-to-face encounter to
help them adhere to treatment plans,
self-manage their medical conditions,
and keep follow-up appointments?
-
Are patient records signed and dated
with progress notes from all providers
who see the patient? Are patient records
maintained with the ongoing listing
of medications in an orderly chart,
which indicates the name of the medication,
dose, and date prescribed, and if
applicable, date ended, for all medications?
-
What are the grantee’s efforts
around risk management? Does the grantee
have written policies and procedures
for risk management (e.g., security
of medical records, pharmaceuticals
and bio-hazardous materials)? How
is staff informed of these policies
and procedures as well as the potential
risks? How are the grantee and staff
implementing risk management procedures
and policies?
- Has
the grantee evaluated their information
system’s capacity for automated
billing, scheduling, and recall to
produce data for program analysis
purposes?
-
Program Location and Facility
• Does the location and equipment
support the implementation and performance
of the intended program?
• If applicable, is the facility
accessible to the population targeted
for services?
• Is the facility’s environment
welcoming to the consumer population
(e.g., layout and design are not in
conflict with cultural practices of
client population, signage is displayed
in appropriate languages, etc)?
• For programs that provide
services of a sensitive nature, such
as HIV/AIDs or sexually transmitted
infections (STI), is patient confidentiality
maintained internally by not indicating
the services provided in signs or
other information posted outside of
the building?
• Does the facility location
impact other entities serving similar
populations?
Outreach
and Consumer Feedback |
Reaching the Target Population
-
How does the grantee identify the
needs of its target population?
-
How does the grantee market its program
to the target population?
-
How does the grantee build trust among
emerging populations?
-
How does the grantee identify barriers
to program services/resources and
reduce/remove these barriers for the
target population, including barriers
for persons with disabilities, language
and/or cultural differences?
-
How does the grantee use information
and data to track changes in the persons/populations
being served by the program?
- Does
the grantee have on staff, as paid
workers or as volunteers, individuals
who are consumers or would represent
the consumer’s interest?
- How
does the grantee assess and track
changes in health care environment
and marketplace? What approaches are
used to address these changes?
Use
of Feedback
-
How has the grantee demonstrated that
they successfully implement programs
that respond to the identified needs
of the population served?
-
How does the grantee solicit feedback
(e.g., consumer satisfaction surveys)
from those served by the program?
-
How does the grantee use this feedback
within its program?
-
Is feedback provided to providers
on their performance?
-
What is the “feedback loop”
between the grantee and those being
served, as well as the larger community/population
groups targeted for services?
Business
and Financial Management |
Program Budget Aligned with
Goals and Objectives
-
Does the budget reflect the priority
program goals and objectives and is
it aligned with the priority needs
of the consumer population?
-
Is the budget well justified, including
any maintenance of effort and/or Federal
matching fund requirements?
-
How does the grantee demonstrate that
fiscal resources are allocated properly
to complete the program goals and
objectives?
-
Do expenses follow the program purpose
and priorities?
Financial
Management
-
Does the grantee have an adequate
plan for the use of HRSA funds, including
systems in place to reduce erroneous
or improper payments?
-
Does the grantee draw down HRSA funds
from the Payment Management System
(PMS) using a reasonably apportioned
rate?
-
How has the grantee performed in the
oversight of funds and contracted
services and in its overall fiduciary
responsibilities? Are funds disbursed
in a timely manner?
-
Does the grantee have incentives and
procedures to measure and achieve
efficiencies and cost effectiveness
in program execution? What results
has the grantee achieved in effecting
economies of scale and cost efficiencies
in administrative functions?
-
Does the grantee use strong financial
management practices? Are financial
systems maintained which provide internal
controls (i.e., no co-mingling of
funds), safeguard assets, maintain
adequate cash flow, and maximize revenue
from all sources? Are required audits
conducted in a timely manner? Are
employee payroll taxes paid on a timely
basis?
-
Has the grantee taken meaningful steps
to address its identified financial
management deficiencies, including
any audit findings?
Reimbursement for Patient Services
(For Grantees Involved in Patient Care)
-
What steps is the grantee taking to
maximize available third party reimbursement?
Is there a system in place for timely
third-party billing?
-
How does the grantee enroll patients
in applicable insurance programs?
-
Does the grantee have policy, structures,
and procedures in place that enable
staff to collect sensitive financial
information from consumers?
-
Does the grantee provide Medicaid/Medicare
reimbursable services? Is the grantee
a certified Medicaid/Medicare provider?
Does the grantee appropriately negotiate
with, bill, and collect funds from
Medicaid/Medicare?
-
Does the grantee have an established
billing system in place, including
a schedule of charges (caps) and sliding
fee scale (discounts), where appropriate?
- How
often does the grantee provide in-service
training for employees with responsibility
for coding and billing to assure that
the latest information is appropriately
utilized? Does the grantee have a
system in place to "spot check"
their coding efforts?
-
Does the organization have adequate
systems in place to operate effectively
under managed care?
-
How are other funding sources coordinated
with the HRSA program, including participation
in the Section 340B Drug Pricing Program?
-
To what extent does the grantee collaborate
with other organizations to address
the needs of consumers?
Leadership and Strategic Priorities
-
How does the grantee leadership team
promote the vision, mission, values,
and strategic priorities of the program
internally and externally? Are other
HRSA funded programs aware of the
grantee’s mission and strategic
priorities?
-
How do consumers and employees provide
input to the strategic program priorities?
- How
does leadership address internal and
external forces (market, community,
and State) that may impact on performance?
- How
does the grantee assure that strategic
program priorities and emerging issues
are addressed?
- What
does the leadership see as their most
effective practices and outstanding
program outcomes? How do these practices/program
outcomes compare to other like organizations
and are they worthy of replication?
How does the leadership draw upon
the expertise of community leaders,
stakeholders, and community constituency
groups?
Staff Qualifications, Characteristics,
and Skills
-
How does the grantee assure that staff
possesses the appropriate skill sets,
competencies, and credentials required
to perform their assigned duties?
-
What commitment has the grantee made
to improving staff skills and competencies?
-
How does the grantee assure that the
staff is culturally competent and
responsive to the needs of the population
being served?
- Does
the staff reflect the diversity (in
terms of culture, race, ethnicity,
and language spoken) of the population
served?
- Is
there sufficient staff in place, with
appropriate training and credentials,
to effectively provide the services
the grantee has been funded to provide?
Workforce Stability
-
Has there been frequent turnover in
program leadership and key management
positions?
-
Has there been frequent turnover in
program leadership?
-
What are the staff turnover patterns?
Does the grantee consistently and
quickly fill vacant positions?
-
How is staff turnover tracked and
analyzed?
-
Does the grantee have a current Recruitment
and Retention Plan (development tools
on the NHSC website) for all positions,
especially clinical, and do they utilize
available recruitment tools, i.e.
3RNet, Practice Sights, etc., to their
maximum?
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