Rural Hospital Flexibility Performance Monitoring Project- Grant Years 2003-2008

Lead researcher:
Project funded:
September 2003
Project completed:
August 2008
Under contract with the federal Office of Rural Health Policy, the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine (the Flex Monitoring Team) are cooperatively conducting a performance monitoring project for the Medicare Rural Hospital Flexibility Program (Flex Program). The monitoring project will assess the impact of the Flex Program on rural hospitals and communities and the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development. The monitoring project has three main components. The first component, 'State Performance Management,' uses a Program Logic Model approach to track state program activities and develop tools that allow states to systematically monitor their accomplishments in the context of Flex Program goals. The second component, 'Institutional Performance,' uses secondary and primary data to assess the impact of the Flex Program on hospital financial status and quality of care, and to develop benchmarks for financial performance and quality improvement for small rural hospitals. The third component, 'Community Impact,' assesses the Flex Program impact at the community level, including the local availability and accessibility of health services, and the value of community partnerships developed with health care organizations. The monitoring project has a strong dissemination component that emphasizes rapid distribution of information to key federal, state, hospital, and community stakeholders. The web site for the Flex Monitoring team includes the updated CAH list, the quarterly e-mail survey results, and an extensive publications list. The web address is In the coming year, the Flex Monitoring Team will continue the three core components in its state-level evaluation strategy: 1) the development and refinement of program logic models for state performance management, monitoring, and evaluation; 2) the analysis and synthesis of the 2004-2005 state Flex grant plans; and 3) continued tracking of CAH conversion and state level activities.


  • Rural Hospital Flexibility Program: The Tracking Project Reports First-year Findings
    WWAMI Rural Health Research Center
    Date: 2001
    In 1999, the Rural Hospital Flexibility Program National Tracking Team made site visits to 24 critical access hospitals (CAHs) in order to determine the extent of program implementation in the states and the approaches that states, hospitals, and communities are taking in using the Flex Program to achieve improvements in rural healthcare.
  • The State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
    Policy Brief
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 04/2007
    To understand the priorities/accomplishments of state Flex Grant Programs, the Flex Monitoring Team asked Flex coordinators to identify and discuss their states' three most successful initiatives in the last two years. Interviews were conducted with Flex coordinators and State Office of Rural Health staff in 45 states.
  • State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
    Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center, University of Minnesota Rural Health Research Center
    Date: 10/2007
    This report explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural healthcare infrastructure and discusses which activities were considered most successful by state Flex coordinators.