Health Care for Vulnerable Travis County Residents: A Public-Private - - PowerPoint PPT Presentation

Health Care for Vulnerable Travis County Residents: 
 A Public-Private Partnership


Presentation #3
 
 
 
 


May 22, 2013

Remarks by Central Health Board of Managers Chairperson Rosie Mendoza

Agenda

• 1. Opening Remarks
• 2. Presenter: Greg Hartman
• 3. Presenter: Dr. Andy Agwunobi
• 4. Presenters: John Stephens and David Hilgers
• 5. Presenter: Trish Young Brown
• 6. Public Comment
• 7. Board Discussion
• 8. Closing Remarks

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Remarks By Greg Hartman, President and CEO Seton Medical Center Austin;
 University Medical Center Brackenridge; and
 Network Communications, Advocacy and Marketing
 Seton Healthcare Family

Remarks from Dr. Andy Agwunobi, Director Berkeley Research Group, LLC

Health Care for Vulnerable Travis County Residents: A Public-Private Partnership
 


Presentation #3
 A Review of Lease & Services Agreement and an impact analysis of the Master Agreement
 


May 22, 2013 John Stephens, Project Manager

The Master Agreement


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The Master Agreement (MA) accomplishes three main community objectives:

• 1. Implements the Mandate of Voters
• 2. Strengthens the Safety Net
• 3. Transforms the Delivery System

Discussion Outline

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The following presentation examines four areas:

• 1. Risk analysis, based on community concerns

and how the MA mitigates those risks

• 2. Benefits to the community
• 3. Discussion of Lease Agreement
• 4. Discussion of Services Agreement

Community Risk Analysis

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The Master Agreement aligns incentives with our shared mission and mitigates risk. The following issues are posed as frequently asked questions from community members, public officials, and health care professionals:

• 1. Will we lose the safety net hospital?
• If the hospital is a building, we will still own UMCB
• If itʼs an institution, we have strengthened our hold
• If Seton defaults or breaches, we can buy Teaching

Hospital, equipment, licenses

Community Risk Analysis

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• 2. Will we lose access to womenʼs healthcare services?
• Access to women's health services has been

maintained since the beginning of the lease for UMCB

• Our goal is not only to maintain these services, but to

expand them - as we have done through our network of providers

• Central Health has the unilateral right under the Master

Agreement to approve, fund, and deliver any womenʼs health care services allowable by law

Community Risk Analysis

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• 3. Does Seton have a financial advantage in the Master

Agreement?

• Seton agrees to provide the same level of care it currently

provides for the same value of compensation

• Seton is contributing $250 million of its own funds to

improve hospital care

Community Risk Analysis

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• 4. Will Seton have a financial advantage in the future?
• Under the Master Agreement, Seton cannot impose additional payment

from Central Health unilaterally

• If a funding deadlock arises, then we have an agreed upon dispute

resolution process

• If itʼs still not resolved, Seton (or Central Health) has the option to

terminate

• If Seton terminates, they must provide services for at least 5 years at

the same cost

• If Seton does not provide those services, then Central Health has
• ption to buy the Teaching Hospital

Both parties have a substantial interest in making this agreement work.

Community Risk Analysis

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What are some of the risks inherent to the healthcare industry?

• Under-performance of projects funded by the 1115

Waiver

• Regulatory or other external changes
• And how will we deal with them?
• We will need to be vigilant in responding to the

changing healthcare environment, policies and other external and internal factors.

Community Benefits

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The voters are getting what they voted for – the November 6, 2012 ballot language included a broad range of services:

“Approving the ad valorem tax rate of $0.129 per $100 valuation in Central Health, also known as the Travis County Healthcare District, for the 2013 tax year, a rate that exceeds the district's rollback tax rate. The proposed ad valorem tax rate exceeds the ad valorem tax rate most recently adopted by the district by $0.05 per $100 valuation; funds will be used for improved healthcare in Travis County, including support for a new medical school consistent with the mission of Central Health, a site for a new teaching hospital, trauma services, specialty medicine such as cancer care, community-wide health clinics, training for physicians, nurses and other healthcare professionals, primary care, behavioral and mental healthcare, prevention and wellness programs, and/or to obtain federal matching funds for healthcare services.”

Community Benefits

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What The Community Gets From This Agreement 1. New Medical School

• Economic benefits
• Construction jobs

2. New Teaching Hospital that will serve as the safety net hospital

• Economic benefits
• Construction jobs

3. Transformed Delivery System that is improved in every measurable way 4. Increased Transparency 5. More open meetings and opportunity for public input 6. A more secure and sustainable safety net system

Community Benefits

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What The Community Gets From This Agreement 7. Better access to care for our most vulnerable populations including:

• expanded hours for primary and specialty care
• More workers on the job
• More kids in school

8. More healthcare providers 9. Shorter wait times in the ER at public and private facilities

• 10. Better behavioral and mental health services
• 11. 26 DSRIP projects, including womenʼs health, behavioral health,

primary and specialty care, information technology

• 12. Greater certainty on continuity of hospital care
• 13. Option to purchase the Teaching Hospital if Seton defaults or

breaches

Omnibus Healthcare Services Agreement Between
 Central Health 
 and
 Seton Family of Hospitals


David Hilgers, Legal Counsel


Purpose of Services Agreement

• Establishes the current level of services provided by Seton

to MAP and charity care patients (“Current Services”)

• Establishes value currently received by Seton for the

provision of Current Services (“Current Funding”)

• Important because the Master Agreement requires Seton

to maintain the Current Services at the Current Funding Level throughout the term of the Master Agreement and for five years thereafter

• Establishes a process for the parties to agree to change

the Current Services or the Current Funding

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Major Provisions

• 1. Attaches a list of current services being provided by

Seton to MAP and Charity Care patients.

• 2. Establishes a value of $56,300,000 as the value

presently received by Seton for these services. This value is provided through local and Federal funds received by Seton through the Disproportionate Share (DSH) and uncompensated care program.

• 3. This current level or value cannot be changed without

the approval of both parties.

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Major Provisions

• 4. Provides an audit mechanism to allow CH to determine

if Seton is meeting the following requirements established by the Agreement:

• Access to care requirements
• The Level of Services requirements
• Clinical Quality and Patient Satisfaction requirements

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Major Provisions

• 5. Provides a process by which the parties will review the

level of services and value. Any changes must be approved by both parties and documented in writing.

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Changes

• Either party can propose changes to the Agreement
• No changes to the following without agreement of the

CCC and the execution of a definitive agreement:

• Eligibility for MAP or Charity Care patients
• Amount of co-payments
• Value of services
• Changes in level or availability of services
• Number of MAP patients
• Changes that adversely affect Seton or Seton providers

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Changes in Location


• f Services
• Seton may change the sites at which these services will

be provided

• Central Health must be notified prior to any such changes

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Term and Termination

• Term is 25 years
• The termination provisions are not finalized, but will

track the termination provisions of the Master Agreement and will provide for the continued delivery of services during the Post-termination period.

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Lease Agreement Between
 Central Health
 and
 Seton Family of Hospitals

David Hilgers, Legal Counsel

Role of this Lease in the Master Agreement

• This Lease will govern the continued leasing by Seton of UMCB.
• It will remain in place until the new Teaching Hospital is completed

and a lease is signed between Seton and Central Health for the Teaching Hospital.

• This Lease sets forth the obligations of the parties while Seton is

leasing UMCB.

• We tried to retain as much of the existing Lease as made sense

given the creation of the Master and Services Agreements.

• The Lease needs to assure Central Health that Seton will continue

to lease the Hospital during the Post-Termination Period agreed to in the Master Agreement.

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Lease Obligations of Seton

• Seton shall lease the entire campus except for the “Clinic,”

which shall be controlled by Central Health.

• Lease payment is unchanged from that approved by the

Board in the 3rd Amendment to the Lease.

• Periods of “catch up” for unpaid rent from October 1, 2012.
• Term ends on October 1, 2055.
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Uses of Facility

• Seton must maintain UMCB as a part of the safety net

system.

• Must provide essential community services:
• Level 1 Trauma Center or its equivalent if Level 1 designation

doesnʼt exist.

• Maternity and womenʼs services (excluding services that violate

the ERDs).

• Seton cannot restrict the exercise of religion by any

patient or visitor.

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Standard Ground Lease Provisions


No Substantive Changes – Seton is responsible

• Maintenance and repair
• Observance of environmental law
• Insurance
• Indemnity for claims arising from operations
• Casualty
• Condemnation

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Termination Provisions

• 1. These provisions are not final, but should provide for co-

termination with the Master Agreement.

• 2. Will also provide that if the New Teaching Hospital is not

built, Seton will lease UMCB during the Post-termination period in order to provide the Post-termination services.

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Guarantee Lease Payment

Setonʼs parent company, Seton Healthcare Family, guarantees the performance of Seton Family of Hospitals.

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What the Master Agreement Provides to Our Community

Patricia A. Young Brown, Central Health President & CEO

Five Main Benefits of the Master Agreement


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1. Continues and strengthens the ability of Central Health to provide quality healthcare within the tax rate approved by the voters. 2. Ensures 5 years notice before Seton can alter the current level of services. 3. Provides an option to acquire the new hospital if Seton breaches the Master Agreement. 4. Allows Central Health to oversee and exercise substantial control

• ver the Integrated Delivery System and DSRIP projects.

5. Provides for a new safety net hospital.

The Master Agreement: What we are trying to Accomplish


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• 1. Implements the Mandate of Voters
• Consistent with the Letter of Intent signed in April

2012

• Central Health has remained consistent throughout

the process by focusing on fulfilling the mandate of the voters to:

• Build a new medical school
• Build a new teaching hospital
• Create an integrated delivery system with enhanced care

The Master Agreement: What we are trying to Accomplish


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• 2. Strengthens the Safety Net
• Improves infrastructure, protects current services and enhances

care through the medical school, teaching hospital and Community Care Collaborative

• Central Health is better positioned to be responsive in meeting

service needs through a strengthened partnership and more secure terms

• Creates sustainability into the future

The Master Agreement: What we are trying to Accomplish


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• 3. Transforms the Delivery System
• The CCC – the new integrated model improves our ability to

deliver services

• Builds upon the mission alignment between the partners
• Leverages taxpayer monies to maximize federal match for local

services

Public Comment

Board Discussion

Closing Remarks by Central Health Board of Managers Chairperson Rosie Mendoza