Minutes of the Academic Medical Centers and Hospitals Committee of the Board of Trustees of the State University of New York May 1, 2013

Transcription

1 Minutes of the Academic Medical Centers and Hospitals Committee of the Board of Trustees of the State University of New York May 1, 2013 Pursuant to a notice of meeting duly given on April 18, 2013, the Academic Medical Centers and Hospitals Committee of the Board of Trustees of the State University of New York held a meeting on May 1, 2013 at the State University of New York, College of Optometry, 33 West 42 nd Street, New York NY and through various video locations. Committee Members Present: (John Murad, Chair) Trustee Hunt Trustee Lewin Trustee Lichtman (via video, Rochester) Trustee Sanford (via video, Armonk) Trustee Staller Other Trustees Present: Trustee Belluck (via video, Plattsburgh), Trustee Dullea (via video, Cornell), Trustee Fatta (via video, Buffalo), Chairman McCall, Trustee O Brien (via video, Brockport), Trustee Rea, Trustee Warren-Merrick, Trustee Spielvogel, Trustee Ehrenberg (via video, Cornell) Others Present: Ms. Lora Lefebvre, Committee Liaison Chancellor Nancy Zimpher, Mr. Brian Hutzley, Ms. Stacey Hengsterman, Mr. William Howard, Ms. Ruth Booher, Dr. John Williams, Dr. Michael Lucchesi, Dr. Kenneth Kaushansky, Mr. Gary Bie, Mr. Thomas Bodenberg, Dr. Louise A. Prince, Mr. James Legault, Ms. Carolyn Santora, Ms. Christine McMullan, Ms. Elisa Horbatuk The Academic Medical Centers and Hospitals Committee meeting was called to order by Trustee John Murad at 2:39 p.m. on Wednesday, May 1, 2013 at the College of Optometry, State University of New York. Mr. Murad asked each of the members to identify themselves with their title and as to whether they were a member of the committee. Mr. Murad noted that the meeting notice and agenda had been distributed to the Trustees and public. Mr. Murad asked for a motion to approve of the agenda. The motion passed and the agenda was adopted at 2:39 p.m. Mr. Murad asked for a motion to approve the minutes. The motion passed and the agenda was adopted at 2:42 p.m.

2 Mr. Murad noted the next presentation on the agenda would be the Quarterly Report of the Quality and Patient Safety Data: Focus on Readmission Metrics. Mr. Murad asked Ms. Lefebvre to begin the presentation. Ms. Lefebvre noted that today s presentation would focus on 30-day readmissions. Ms. Lefebvre stated the definition of 30-day readmissions was in the handout. In addition Ms. Lefebvre discussed the reason for readmissions of which some can be avoided and some cannot. Ms. Lefebvre further noted that 76% of these readmissions could be avoided. Ms. Lefebvre discussed the financial impact of readmissions on provided. She noted that hospitals will receive reduced reimbursement if readmission rates are not in line with specific metrics. Ms. Lefebvre noted that readmission requirements started with certain diseases, but now is expanding. Ms. Lefebvre noted that certain readmissions are out of the control of the hospitals such as a patient who does not follow discharge instructions. Ms. Lefebvre reviewed the 30 Day Readmission Rate (All Causes) and 30 Day Related Readmission Rate charts. Ms. Lefebvre asked Ms. Carolyn Santora to present Stony Brook s 30-day readmissions program. Ms. Santora noted that Stony Brook's efforts to address readmission began in October of Ms. Santora noted that their efforts today have not had a significant impact on readmission rates, but believes future readmission rates will be positively impacted. Ms. Santora reviewed Stony Brook s defined best practices and Stony Brook s interventions. Ms. Santora discussed such interventions such as the ACE Tracker, SpectraMD, BOOST, and Team G. Ms. Santora discussed their program to coordinate care across multidisciplinary teams. Ms. Santora noted that they used teach-back to educate staff to reduce readmissions. Ms. Santora also discussed medical reconciliations at all transitions through the use of EMR, and capturing of pharmacy at registration. Ms. Santora discussed other components Stony Brook's activities to reduce readmissions which included engagement of care givers, addressing palliative or end of life care, establishment of communication with providers, and the scheduling of appointments prior to discharge. Ms. Santora discussed Stony Brook's efforts to conduct follow up calls to patients/caregivers with 48 to 72 hours after discharge. Ms. Santora noted that Stony Brook s plan is to provide timely and accurate transfer of information to post-hospital care givers and providers. Ms. Santora reviewed 30 day readmissions chart by core measures. She noted that they are making progress in heart failure, but still had challenges with pneumonia. Ms. Santora reviewed the readmission dashboard and noted that it is consistent with the previous chart. Ms. McMullen reviewed the chart and timeline of Stony Brook s effort to reduce readmissions Dr. Prince presented Upstate s efforts related to reducing readmission. Dr. Prince noted that they just hired a full time coordinator of care and this showed the importance of this issue to Upstate. 2 P age

3 Dr. Prince discussed Syracuse Hospital Executive Council (HEC). Dr. Prince noted that Upstate was participating in a pilot project with 3M and HEC which included chart audits to identify potentially preventable readmissions, readmissions that were not preventable, and potentially preventable with palliative care and/or hospice. Dr. Prince discussed participation in the UHC partnership for patient s project. Dr. Prince noted the development for implementation of interventions on one unit using recognized best practices. Dr. Prince noted that UHC identified five performance measures related to readmissions. Dr. Prince reviewed charts for each of the metrics. Dr. Prince reviewed Upstate s current readmission interventions which included Cipher Health post-home discharge call, heart failure coordinator, transition coaching, patient & family-centered care, and participation in Ohio Children s Hospitals Solutions for patient safety. Dr. Prince reviewed planned targeted interventions to reduce readmissions. These include hospice partnership; follow up appointments at discharge with all patients, partnership with accountable care organization, multidisciplinary rounding process/discharge process improvement, and partnership with Syracuse Community Health Center, pediatric transitional care to adult hood, discharge summary improvement, and establishment of a geriatric emergency department. Dr. Prince also noted partnership with home care for specific diseases and partnership with SNF s. Trustee Lichtman asked if Upstate considered putting SUNY Staff at SNFs. Dr. Prince indicated that Upstate has considered this option. Trustee Lichtman noted that the SNF must go under recertification and that having SUNY staff might assist them. Trustee Dullea asked how the targets for the metrics were established. Dr. Prince indicated the targets were similar to CMS targets. Dr. Lucchesi reviewed Downstate s readmission initiatives. Dr. Lucchesi noted that it is extremely important to get patients out of hospital as soon as possible. However, he noted that it has to be done correctly and safely. Dr. Lucchesi noted that best way to reduce readmission rates is through the use of information technology. Dr. Lucchesi discussed the impact of value based purchasing on readmissions. Dr. Lucchesi noted that there are many stakeholders that have an interest in readmissions beyond patients and providers. Dr. Lucchesi discussed Downstate s efforts to reduce readmissions through the use of Information technology. Dr. Lucchesi discussed the recruitment of a dedicated outpatient case manager to improve transition of care from hospital to home, and assist in coordination of care with primary care physicians and specialty providers. Dr. Lucchesi also discussed partnership with Visiting Nurses Service of New York, referrals other providers, and participation in Greater New York Hospital Association and Hospital Association of New York. Dr. Lucchesi reviewed the readmission dashboard noting the areas they Downstate still had challenges. Dr. Lucchesi reviewed the barriers to success but noted that he felt Downstate was up to the challenge. Dr. Lucchesi reviewed the prescription program of inpatient discharges. 3 P age

4 Trustee Fatta asked how big a problem is the many languages of the patients. Dr. Lucchesi noted that the hospital has phones that can be brought to patients to interpret for the staff. Trustee Lewin asked how you manage patients who cannot read. Dr. Lucchesi stated that this is a difficult problem and it is key to keep in contact with those patients. Dr. Williams noted that this is why safety net hospitals are so important and different from other hospitals. Trustee Belluck asked if risk management was part of the discussion on readmissions as it is in most other hospitals. Dr. Lucchesi noted that risk management is tied directly to quality program. Mr. Murad thanked all the presenters for a very good presentation. Mr. Murad noted that the next topic was the Stony Brook affiliation with Southampton Hospitals. Dr. Stanley discussed the growth of Stony Brook and the importance of the medical school and hospital to the campus. Dr. Stanley also noted the importance of the Southampton alliance to the continued success at Stony Brook. Trustee Spielvogel asked why SUNY needed to operate a hospital. Dr. Stanley noted that the hospital can provide resource and benefits to the educational programs that would not be available without the hospital. Dr. Kaushansky provided an overview of University Hospital at Stony Brook. He further noted that the hospital financials are sound. Dr. Kaushansky noted that the hospital is beyond full and the Stony Brook is a very busy hospital. Dr. Kaushansky noted that Stony Brook has been able to absorb significant reductions in State support through a variety of operation initiatives. Dr. Kaushansky discussed the Hospitals initiative to manage length of stay through the use of hospitalist, case management and nursing homes. Mr. Murad made a motion to go into executive session at 4:00pm. Motion was approved. Return from executive session at 5:35. Mr. Murad asked that we move on to an update on Downstate. Ms. Lefebvre reviewed what was included in the budget. Ms. Lefebvre noted that we asked for $87 million for hospital support, $35 million for Upstate and $150 million for support for Downstate. Ms. Lefebvre indicated that the enacted budget included $60 million in State support and $27.8 million in support funded by DRL savings. Trustee McCall asked if the budget directed how these should be split. Ms Lefebvre responded that the $27.8 million was directed to be split equally among the three hospitals. Ms. Lefebvre also discussed section Q in the public health law which directed that a sustainability plan for Downstate with consultation with various stake holder groups. Ms. Lefebvre noted that the plan must be submitted for review by June 1, In addition, Ms Lefebvre discussed other components of the section Q. Mr. Lefebvre also noted that the budget allowed for the movement of funds related to the MRT/DSRIP initiative. Dr. Williams reviewed the process currently underway to prepare the sustainability report. 4 P age

5 Dr. Williams noted that the process to develop the sustainability plan began immediately. Dr. Williams stated that an academic team has been established to review the operations of the medical school and other schools. Dr. Williams also noted that they are doing service line reviews and are bringing in more money than ever. Dr. Williams also noted that the plan will include various options and the economic impact of each option. Dr. Williams also noted that he will be meeting with the Brooklyn delegation soon. Ms Lefebvre noted that one of the key stake holders is DOH, but at the present time SUNY is prohibited from discussions with them as a result of the TRO. Ms. Lefebvre discussed the issuance of the RFI for LICH. Mr. Murad made a motion to enter executive session. Motion was passed at 5:41. Exective sessions ends at 6:09. Mr. Murad made a motion to adjourn. Motion was passed at 6:10. 5 P age