Georgia State Office of Rural Health Presentation to: SORH Working with Vulnerable Hospitals - NORSORH Presented by: Lisa Carhuff – Hospital Services Director 0 Date: 07 December 2016
Mission The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through planning, purchasing and oversight We are dedicated to A Healthy Georgia. 1
State Office of Rural Health The programs highlighted today include: • Initial Collaboration – Southern Hospital Sustainability Committee • Update on Georgia closures • Rural Hospital Stabilization Committee Programs • Pilot Hospitals • FY17 Hospitals • Patient Centered Medical Home • Senate Bill 258 2
Initial Collaboration • Southern Hospital Sustainability Workgroup – Alabama – Georgia – Mississippi – South Carolina – Bridget Ware – National Rural Resource Center 3
Georgia Hospital Closure Calendar Year End 2016 Update Hospital Closure List 1. Hancock Memorial Hospital 2001 2. Dooly County Hospital 2001 3. Telfair Regional Hospital 2008 4. Hart County Hospital Hartwell, GA and Cobb Memorial Hospital Royston, GA close and consolidate to Ty Cobb Regional Memorial Lavonia GA – June 2012 – Purchased by St Mary’s (Trinity Health) in 2015 renamed St Mary’s Sacred Heart (net loss 1 hospital) 5. Calhoun Memorial Hospital 2013 6. Stewart-Webster Hospital 2013 7. Charlton Memorial Hospital 2013 8. Lower Oconee Regional 2014 9. North Georgia Medical Center 2016 Closed Emergency Room Flint River Hospital 2013 4
Governor’s Rural Stabilization Committee • In April 2014, Gov. Nathan Deal announced his appointments to the Rural Hospital Stabilization Committee, which was created to identify needs of the rural hospital community and provide potential solutions. “ In March of this year, I proposed three revisions to the way we approach rural health care, with one being the Rural Hospital Stabilization Committee, ” Deal said. “ I recognize the critical need for hospital infrastructure in rural Georgia and remain committed to ensuring citizens throughout the state have the ability to receive the care that they need. This committee will work to increase the flow of communication between hospitals and the state and improve our citizens ’ access to health care. I am proud to welcome this team and look forward to what we stand to accomplish. ” • June 9, 2014 – first official convening of Committee 5
Initial Stabilization Work - 2014 • Rural Free Standing Emergency Department (RFSED) – Financial modeling – Licensure Regulations approved – Feasibility Studies - evaluated and found to be financially unsustainable in rural communities • Impact of Obstetrics Closures in rural hospitals • ED Closure and restructure – Mississippi Hospital Experience Combined two clinics and ER into one hospital- based (HB) Rural Health Clinic (RHC) • Hearings from closed and financially fragile hospitals 6
Rural Hospital Economic Impact 7
RHSC 2014 - 2016 2015 •RHSC final report published February 23 2015 •Based on Committee findings, the “ Hub and Spoke ” model was determined to potentially provide the most value to rural hospital communities. Emphasis on the delivery of the “ Right Care, at the Right Time and in the Right Setting •$3M in funding was requested by Governor Deal and appropriated by the Legislature for the FY16 budget •Pilot hospitals identified by the Legislature •Each received $750,000 and required to provide cash match of $100,000 8
RHSC Hub and Spoke FQHCs Technical Board of Schools Education Behavioral CAHs Health Home Public HOSPITALS Health Health EMS Physicians Nursing Local Homes Tertiary Industry Hospitals “the right care, at the right time, in the right setting” 9
Rural Hospital Stabilization Pilot Sites – Phase 1 Appling HealthCare System Towns Dade Catoosa Fannin Rabun Union Murray Whitfield Crisp Regional Hospital Walker Gilmer White Lumpkin Stephens Chattooga Gordon Emanuel Medical Center Pickens Dawson Banks Franklin Hart Hall Forsyth Cherokee Floyd Bartow Union General Hospital Madison Jackson Elbert Polk Barrow Clarke Gwinnett Cobb Oglethorpe Paulding Haralson Lincoln Walton Wilkes DeKalb Fulton Douglas Greene Taliaferro Clayton Morgan Columbia Carroll Newton Henry Warren Fayette Richmond Coweta Putnam Jasper Heard Butts Hancock Spalding Jefferson Burke Pike Lamar Baldwin Troup Meriwether Jones Monroe Washington Upson Jenkins Bibb Wilkinson Screven Johnson Harris Crawford Talbot Twiggs Emanuel Peach Muscogee Taylor Laurens Bleckley Bulloch Houston Candler Effingham Treutlen Chattahoochee Marion Macon Schley Pulaski Evans Dodge Dooly Wheeler Toombs Bryan Stewart Chatham Webster Sumter Tattnall Wilcox Telfair Crisp Liberty Quitman Jeff Davis Long Lee Appling Terrell Ben Hill Randolph Turner Irwin Wayne Bacon Clay McIntosh Coffee Dougherty Calhoun Worth Tift Pierce Early Baker Glynn Berrien Atkinson Brantley Mitchell Colquitt Ware Miller Cook Lanier Seminole Camden 10 Clinch Charlton Decatur Thomas Grady Brooks Lowndes Echols
RHSC Pilot Goals and Implementation Strategy Goals Implementation Strategy Increase community/regional presence Increase Market Share Deploy LifePak 15 EKG to advance STMI diagnosis and appropriate patient destination Stroke Center & Chest Center Designations Occupational Medicine Level 4 Trauma Designation Tele-nephrology Program Mobile Integrated Health Care with EMS &/or nursing staff Reduce Medicare Readmissions Case management Reduce non-emergent care & “ Super Users ” Case management Telehealth (Nursing Homes, Schools, EMS) served in the ED Develop Patient Centered Medical Home with FQHC Increase Primary Care Access School-based health care with direct providers &/or telehealth equipment 11
PILOT PROJECTS Appling Healthcare Crisp Regional Hospital •Chest Pain Center Designation • EMS and Emergency Room Connectivity •School Telemedicine/On-site Clinic • School-Based Telemedicine •Nursing Home – Advanced • Occupational Health Practitioner Placement • Level 4 Trauma Designation •Remote Stroke Center • Patient Care Management Designation •Community Paramedicine 12
PILOT PROJECTS & BUDGETS Emanuel Medical Center Union General Hospital • School/Day Care-Based • Tele-nephrology/inpatient Telemedicine dialysis • Paramedicine Home Visits • Care Coordination • Decrease Inappropriate ED • EMS Telemedicine Utilization – Opioid Target – NH Telemedicine • Tele-neuro/Stroke • Fast Track/Improved ED Through-Put 13
Performance Measures 1. Overall Proxy Measure of Financial Stabilization Hub Focus: Meeting or exceeding CY 2014 Net Revenue Community Focus: Decrease total CHARGES for the Top 25 High Volume (# of admissions/observations for overnight stay) based on the patients living in the defined community (zip code(s)). 2. Access to Care – Inappropriate Utilization of Emergency Department (ED) Care Frequent flyer utilization (cohort of patients with multiple ED encounters with disposition “ discharged ” – exclude admissions/transfers). a. Defined by 5 visits or > in calendar year b. Defined by 10 visits or > in calendar year c. Defined by 20 visits or > in calendar year 14
Performance Measures Readmission Reduction – All Cause Hospital-wide Readmissions 3. – Rate of readmissions within 30 days Mental Health – Average Daily Boarding Hours for 1013 Hold 4. 5. Access to Care – Potentially Preventable Hospital Stays – PQI 90 Ambulatory Care Sensitive Conditions 6. Market Share – Outmigration – Inpatient & Outpatient 7. Improved Fidelity – Hospital Consumer Assessment of Health Care Providers & Systems (HCAHPS) – “ Yes, would definitely recommend the hospital ” 15
Pilot Site Comments • “This has given us the ability to explore new strategies and care opportunities that otherwise might not have been an option due to lack of capitol and risks” • We never anticipated the amount of physician opposition to these projects” • “Although we discussed the need for collaboration , I believe the need is greater than I realized” • “ Change is difficult but necessary for rural hospital survival” • “I spoke in favor of using telemedicine to bring specialty care back to our community; however, I don’t think I realized how far it could go ” • “I hope there continues to be efforts to develop a payment model for community paramedicine” 16
Pilot Site Comments • “The Pilot Project has been more time-consuming than anticipated” • “We have learned a great deal about our own data .” • “One of our most valuable lessons has been communication and education regarding our local CSB . We didn’t know them “ You need a physician champion ” • “ The project forced me, as a CEO, to look at potential activities for • the hospital that I would not have considered, ones which are not either saving us money or generating additional revenue ” “ The Pilot Project has been more time-consuming than anticipated ” • “ We didn ’ t know them and they didn ’ t know us before now. We are • working together for the benefit of our mental patients ” 17
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