Prop Q: CPMC St. Lukes Skilled Nursing Facility & Subacute Unit - - PowerPoint PPT Presentation

San Francisco Department of Public Health Office of Policy & Planning

Prop Q: CPMC St. Luke’s Skilled Nursing Facility & Subacute Unit Closure

August 15, 2017

Prop Q - Overview

• Proposition Q (1988) requires private hospitals in San Francisco to provide

public notice prior to closing a hospital inpatient or outpatient facility, eliminating or reducing the level of services provided, or prior to the leasing, selling or transfer of management

• CPMC’s plans to close its Skilled Nursing Facility (SNF) and subacute unit at

the St. Luke’s campus on October 31, 2017

• In recent years, the Health Commission has reviewed two Proposition Q

closures/reductions related to SNFs in San Francisco.

• CPMC California Campus (2014)
• St. Mary’s Medical Center (2015)

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Prop Q – CPMC St. Luke’s

CPMC St. Luke's Skilled Nursing and Subacute Unit closure will:

1) Decrease the total number of skilled nursing beds in San Francisco by 79 (39 skilled nursing and 40 subacute skilled nursing) 2) Eliminate subacute SNF beds in San Francisco

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Skilled Nursing Facility Overview

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*Subacute patients are medically fragile and require more intensive care

GENERAL SUBACUTE CHARACTERISTIC

2,478 40 Licensed beds in San Francisco

 

24/7 Supervision

 

Physical therapy, occupational therapy, speech therapy

 

Wound care, intravenous therapy, injections, monitoring of vital signs

 

Assistance with bathing, eating, dressing, feeding, transferring, toilet hygiene



Ventilator care, complex wound management, intravenous tube feeding

1) Level of Service 2) Facility Setting

• Hospital-based
• Freestanding

3) Patient Length of Stay

• Short-term patients
• Long-term patients

CPMC Skilled Nursing Beds

Campus Licensed Skilled Nursing Beds 2013 2014 2017 California 101 Davies 38 38 38 Pacific

• St. Luke’s

79

(40 subacute)

79

(40 subacute)

TOTAL 218 117 38

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• Skilled nursing beds across all CPMC

hospitals have declined by 83% since 2013

• Health Commission Resolution 02-10

includes an agreement between CPMC and the Health Commission to provide a total of 100 skilled nursing beds

• This resolution became the foundation for

early drafts of the Development Agreement (DA), however the final DA is silent with regard to the provision of SNF beds

• St. Luke’s SNF Unit – Subacute Patient Demographics

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Residence San Francisco 80% Outside City 20% Gender Female 63% Male 37% Age Age ≤65 60% Age 65+ 40% Payer Medicare 70% Medi-Cal 27% Other <1% Length of Stay 3 months or less 0% 3 months to 1 year 20% 1 year to 2 years 27% 2 years to 5 years 23% 5 years to 8 years 17% 8+ years 13%

Since the Closure Announcement:

• 1 transferred to Kaiser
• 1 passed away
• 1 was weaned off a ventilator and

discharged home

• 1 transferred to O’Connor Hospital

Subacute Unit in San Jose, CA

• St. Luke’s Subacute Patients
• Most are long-term patients
• 24 patients remaining in the unit

• St. Luke’s SNF Unit – General SNF Patients

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• St. Luke’s General SNF Patients
• CPMC’s general SNF beds (n=39) are primarily for short-term stays, with an

average length of stay of two to four weeks

• Most patients are recovering from a surgery, wound, or condition that required

an acute care stay but are not yet able to go home Patients In Unit At Time Of Closure

• CPMC reported 15 patients at the closure announcement in June 2017
• Since the closure announcement, 10 patients were discharged to home, leaving

the current census at 5 patients

San Francisco Skilled Nursing Facility Bed Rate

County Number of Facilities SNF Capacity % Population 65+ Beds Per 1,000 65+ Population Alameda 68 5,352 12% 28 Santa Clara 52 5,148 12% 23 Marin 14 1,038 19% 21 Sonoma 20 1,660 16% 21 Contra Costa 32 3,000 14% 20 San Francisco 21 2,439 14% 20 Napa 4 368 16% 16 Solano 9 846 13% 15 San Mateo 13 1,582 14% 15 California 2,002 113,608 12% 24

With a static bed supply, San Francisco’s total skilled nursing bed rate would decrease from 20 to 12 beds per 1,000 adults 65+ by 2030 If San Francisco were to maintain its current bed rate as the population ages, the city would need 4,083 licensed SNF beds by 2030—an increase of 1,644 beds over the current supply

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Declining Skilled Nursing Bed Capacity in SF

Licensed Skilled Nursing Beds in San Francisco, 2003-2017

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• Since 2003, there has been a 30

percent decline in SNF beds in San Francisco

• This decline is largely due to the

reduction of hospital-based beds (43 percent decline)

• As in San Francisco, nationally, the

number of hospital-based skilled nursing facilities has fallen (63 percent decline from 1999 to 2013)

2,128 1,319 1,216 1,374 1,223 3,502 2,439 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 Hospital-based Freestanding All SNF

General SNF Capacity in San Francisco

• While payer data suggest that most SNF beds

are occupied by long-term patients, facilities are shifting practice towards short-term care

• When hospitals close SNF units, they

increasingly rely on community skilled nursing facilities to provide short-term care

• Increased demand for short-term care in the

community coupled with higher reimbursement for short-term stays, may limit availability for short and long-term Medi-Cal patients

Facility Total Licensed Beds Short-Term Bed Estimate Long-term Bed Estimate Hospital-based SNFs ZSFG 30 30 CPMC Davies 38 38 Jewish Home 379 100 279* Laguna Honda Hospital 769 100 669* Freestanding SNFs 16 Facilities 1,223 583 640** TOTAL 2,439 851 1,588

*As reported by the facility in 2017 **The number of reported Medi-Cal Fee for Service patients in freestanding SNFs on December 31st, 2015.

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Subacute Care Capacity in San Francisco

• Regionally, subacute facilities have limited

capacity - 11% of subacute beds (523) are located in the Bay Area and operate at or near capacity

• Subacute discharges in the county are

relatively small, and some patients receive short-term subacute care in Long-Term Acute Care Hospitals.

• San Francisco patients needing long-term

subacute care are discharged out-of-county

County Number of Beds Number of Facilities Los Angeles 2,193 56 Orange 532 16 San Diego 423 11 San Bernardino 384 8 Santa Clara 223 5 Alameda 149 5 Riverside 139 4 Ventura 114 3 Fresno 83 2 San Joaquin 72 2 Tulare 67 2 Contra Costa 58 2 Sacramento 52 2 Kern 51 1 San Mateo 44 1 Yolo 44 1 San Francisco* 40 1 Monterey 32 1 Sonoma 17 1 Glenn 10 1 TOTAL 4,727 125 * Estimated closure date October 2017

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Ongoing Efforts & Considerations

• The San Francisco Post-Acute Care Collaborative is developing solutions

for high risk individuals needing post-acute care

• The Health Care Services Master Plan update will highlight the need for

skilled nursing care and explore related land use policy recommendations

• The Department of Public Health has initiated regional conversations

regarding post-acute care

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Conclusion

• Access to skilled nursing care, including subacute care, is a citywide and

regional challenge

• Any reduction of skilled nursing care services will limit patient access to this

level of care

• For these reasons, the Department of Public Health recommends that the

closure CPMC St. Luke’s subacute and SNF unit will have a detrimental impact on the health care services in the community

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