Georgia State Office of Rural Health Presentation to: SORH Working - - PowerPoint PPT Presentation

Presentation to: SORH Working with Vulnerable Hospitals - NORSORH Presented by: Lisa Carhuff – Hospital Services Director

Date: 07 December 2016

Georgia State Office of Rural Health

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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.

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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

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Initial Collaboration

• Southern Hospital Sustainability Workgroup

– Alabama – Georgia – Mississippi – South Carolina – Bridget Ware – National Rural Resource Center

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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

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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

• ne 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

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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

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Rural Hospital Economic Impact

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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

9 HOSPITALS

FQHCs Board of Education CAHs Public Health Physicians Local Industry Tertiary Hospitals Nursing Homes EMS Home Health

Behavioral Health Technical Schools

RHSC Hub and Spoke

“the right care, at the right time, in the right setting”

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Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham

Chattahoochee

Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Floyd Forsyth Franklin Fulton Gilmer Glynn Gordon Grady Greene Gwinnett Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin McIntosh Macon Madison Marion Meriwether Miller Mitchell Monroe Morgan Murray Muscogee Newton Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Schley Screven Seminole Spalding Stewart Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Dawson Fayette Jeff Davis Stephens Sumter Toombs

Rural Hospital Stabilization Pilot Sites – Phase 1

Appling HealthCare System Crisp Regional Hospital Emanuel Medical Center Union General Hospital

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RHSC Pilot Goals and Implementation Strategy

Goals Implementation Strategy Increase Market Share  Increase community/regional presence  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 Reduce Medicare Readmissions  Mobile Integrated Health Care with EMS &/or nursing staff  Case management Reduce non-emergent care & “Super Users” served in the ED  Case management  Telehealth (Nursing Homes, Schools, EMS) Increase Primary Care Access  Develop Patient Centered Medical Home with FQHC  School-based health care with direct providers &/or telehealth equipment

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PILOT PROJECTS

Appling Healthcare

• EMS and Emergency Room

Connectivity

• School-Based Telemedicine
• Occupational Health
• Level 4 Trauma Designation
• Patient Care Management

Crisp Regional Hospital

• Chest Pain Center Designation
• School Telemedicine/On-site

Clinic

• Nursing Home – Advanced

Practitioner Placement

• Remote Stroke Center

Designation

• Community Paramedicine

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PILOT PROJECTS & BUDGETS

Emanuel Medical Center

• Tele-nephrology/inpatient

dialysis

• Care Coordination
• EMS Telemedicine

Union General Hospital

• School/Day Care-Based

Telemedicine

• Paramedicine Home Visits
• Decrease Inappropriate ED

Utilization

– Opioid Target – NH Telemedicine

• Tele-neuro/Stroke
• Fast Track/Improved ED

Through-Put

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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

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Performance Measures

3. Readmission Reduction – All Cause Hospital-wide Readmissions

– Rate of readmissions within 30 days

4. Mental Health – Average Daily Boarding Hours for 1013 Hold 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”

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Pilot Site Comments

• “This has given us the ability to explore new strategies and care
• pportunities that otherwise might not have been an option due to lack
• f 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
• ur 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”

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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”

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Challenges We Have Observed…..

• Low volume, Lack of community support
• Physician Engagement & Willingness to Change
• Community Education & Engagement
• Cultural & Lifestyle Challenges
• Timely data ~ evaluate, change, adapt, re-evaluate
• Connectivity relating to telehealth
• Sharing of data… difficult to coordinate care without
• Trust Among Community Partners ~ the right care, at the right

time…. May not be my place of business

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RHSC FY17 Hospitals

• $3,000,000 Appropriated – Signed by Gov. Deal
• 4 Sites Identified
• 1 Site Opted Out
• $1,000,000 Grants executed – August
• Grant Period – August 2016 – June 30, 2018

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Community Health Care Workgroup

Expectations:

– Organize, convene the local health care network of spokes; strong participating presence expected – Engage them in conversations and work to develop partnerships with mutual benefit – Establish a regular meeting schedule – Share grant funds with partners (spokes) – Recognize that you may not develop a relationship with 100% of those in your community networks ~ unfortunate reality

• Expectation is to try

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RHSC FY17 Hospitals

• Habersham Medical Center

– Rural PPS Hospital

• Miller County Hospital

– Critical Access Hospital

• Upson Regional Medical Center

– Rural PPS Hospital

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RHSC FY17 Hospitals

Habersham Medical Center

• ER Screen / PrimeCare

Expansion

• Telemedicine
• 340B Pharmacy Program
• Community Paramedicine

Upson Regional Medical Center

• Care Coordination
• Tele-Medicine
• Establish a 10-12 bed

Geriatric Psychology Inpatient Unit

• Student Pipeline for

recruitment

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RHSC FY17 Hospitals

Miller County Hospital

• Care Coordination Model
• Mental Health Collaboration
• Emergency Room Redesign

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Patient Centered Medical Home - $300,000

• Legislatively budgeted in

FY17 for adoption of PCMH in small rural physician practices

– Competitive solicitation – Up to $15,000 per site

What we learned….

– Information dissemination channels were limited – Limited knowledge of PCMH by rural GA hospitals and clinics – Perception that application was too difficult (“didn’t even look at it”)

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SB 258 -Tax Credit Program Rural Hospitals

• In order to be eligible for the tax credit program, a hospital must, among other things,
• have at least 10% of its annual net revenue categorized as indigent care, charity care or bad debt;

and

• file a five-year plan with the Department of Community Health, detailing the financial viability

and stability of the hospital.

• Donations received by a hospital under the tax credit program must be used for the provision of

health-care related services for residents of a rural county or for residents of the area served by the critical access hospital.

• For individuals, tax credits are limited to 70% of the donation amount or $2500 for an individual and

$5000 for couples, whichever is less.

• For corporations, tax credits are limited to 70% of the donation amount or 75% of the corporation's

income tax liability, whichever is less.

• Total aggregate tax credits available each year are limited to $50 million in 2017, $60 million in

2018 and $70 million in 2019. http://dch.georgia.gov/rural-hospital-tax-credit

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SB 258 -Tax Credit Program Rural Hospitals

49 rural hospital organizations determined initially eligible to receive donations

Initial Requirements

• FORM 990 (Proxy)
• FIVE-YEAR PLAN FOR UTILIZATION OF TAX CREDIT DONATIONS

PURPOSE: The five-year plan will include strategies to address debt, uncompensated care and other challenges to the fiscal viability and stability of critical access and small rural hospitals through the use of tax credit donations.

• DUN & BRADSTREET SUPPLIER EVALUATION REPORT

PURPOSE: To demonstrate the hospitals’ financial viability and stability,

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POINTS OF CONTACT

Patsy Whaley Executive Director State Office of Rural Health 229-401-3081 pwhaley@dch.ga.gov Lisa Carhuff Director, Hospital Services State Office of Rural Health 229-401-3092 lisa.carhuff@dch.ga.gov