MOUNT VIEW CARE CENTER COMMITTEE (MVCC)

Transcription

1 MOUNT VIEW CARE CENTER COMMITTEE (MVCC) AGENDA Date & Time of Meeting: Monday, May 7, 2018 at 5:30 PM Meeting Location: Board Room, North Central Health Care, Wausau, WI Mount View Care Center Committee Members: John Robinson, Chair; Katie Rosenberg, Vice-Chair; Tim Buttke, Allen Drabek, Romey Wagner, Jack Hoogendyk Marathon County Mission Statement: Marathon County Government serves people by leading, coordinating, and providing county, regional, and statewide initiatives. It directly or in cooperation with other public and private partners provides services and creates opportunities that make Marathon County and the surrounding area a preferred place to live, work, visit, and do business. (Last updated: ) 1. Call Meetings to Order 2. Public Comment 3. Approval of Prior Meeting Minutes 4. Educational Presentations/Outcome Monitoring Reports None 5. Policy Issues Discussion and Committee Report to the Health and Human Services Committee about the Future of Mount View Care Center A. Preparing for Presentation of Final Report and Recommendations of the MVCC Committee to the Health and Human Services Committee including these elements: 6. Adjourn Meeting a. Service Delivery Mix b. Physical Plant Renovations c. Governance of MVCC d. Management Agreement with North Central Health Care e. Ability of MVCC to Service a 20 Year Debt Repayment Any person planning to attend this meeting who needs some type of special accommodation in order to participate should call the County Clerk s Office at or infomarathon@mail.co.marathon.wi.us one business day before the meeting. SIGNED /s/ John Robinson Presiding Officer or Designee FAED TO: Wausau Daily Herald, City Pages, and NOTICE POSTED AT COURTHOUSE FAED TO: Other Media Groups FAED BY: BY: Brad Karger FAED DATE: DATE: FAED TIME: TIME:

2 MOUNT VIEW CARE CENTER (MVCC) COMMITTEE MINUTES Tuesday, April 24, 2018 at 6:00 p.m. Employee Resource Conference Room, Courthouse, Wausau WI Attendance: Present Absent John Robinson, Chair Katie Rosenberg Tim Buttke Allen Drabek Jack Hoogendyk Others Present: Bill Miller, Brian Kowalski, Brad Karger, Michael Loy, Brenda Glodowski, Kim Gochenhauer, Brad Karger, Kurt Gibbs, Brenda Budnik, Bill Metter 1. Call Meeting to Order Meeting was called to order by Chair John Robinson at 6 p.m. 2. Public Comment - None 3. Approval of Prior Meeting Minutes MOTION BY BUTTKE, SECOND BY DRABEK TO APPROVE THE MINUTES OF THE APRIL 9, 2018 AND THE JANUARY 29, 2018 MEETINGS. MOTION CARRIED. 4. Final Report Discussion: Michael Loy, Michael Peer, Alana Carter discussed the renovation plan for the NCHC Campus. The renovations for the entire campus produces enough savings and revenues to service the debt but it if look at MVCC alone it does not cash flow: MVCC will result in an $11,179,000 deficit and the other NCHC Programs will produce a $12,860,000 surplus. Cost estimates include design, equipment, furniture and contingencies. Common area have been allocated 60% to MVCC. Current County Levy revenue allocated to MVCC (1.5 million) will stay the same. County levy is roughly equivalent to the County s cost of protective placements. The renovation cost of MVCC alone is 25 million dollars. Action: MOTION BY BUTTKE, SECOND BY ROSENBERG TO APPROVE THE FINAL REPORT AND RECOMMENDATION AS WRITTEN IN THE MEETING PACKET AND PASS THE INFORMATION FORWARD TO THE HEALTH AND HUMAN SERVICES COMMITTEE FOR THEIR CONSIDERATION. MOTION CARRIED.

3 5. Next Meeting and Adjournment: MOTION BY BUTTKE; SECOND BY DRABEK TO ADJOURN THE MVCC MEETING. MOTION CARRIED. Meeting adjourned at 6:25 p.m. There was no discussion of any subsequent meetings. MINUTES PREPARED BY BRAD KARGER ON APRIL 25,

4 UPDATED DRAFT DATE: April 20, 2018 TO: Marathon County Board of Supervisors Marathon County Health & Human Services Committee FROM: Mount View Care Center Committee RE: Final Report and Recommendation of the Mount View Care Center Committee Committee Purpose The Mount View Care Center (MVCC) Committee, a sub-committee reporting to the Health and Human Services Committee, was created to develop broad policies that guide the operation of Mount View Care Center, a public, skilled nursing home, owned by Marathon County and managed by North Central Health Care (NCHC). Specifically, the Committee duties and responsibilities were to develop policies and monitor performance as follows: 1) Assess community needs and determine services offered by MVCC. 2) Right-size the facility to best meet market demand and maximize operational efficiencies. 3) Establish goals with regard to the payer mix necessary to support operations. 4) Recommend changes to the physical plant to improve financial performance and/or patient care. 5) Monitor survey results and oversee operational changes made to improve patient care. 6) Monitor the financial success of the facility. The MVCC Committee regularly met jointly with the NCHC Board s Nursing Home Operations Committee for input and collaboration on the duties and responsibilities described above. The NCHC Nursing Home Operations Committee was created by the Marathon County Board around 2006 to manage MVCC operational and policy issues. At the NCHC s Board meeting on February 22, 2018, the NCHC Nursing Home Operations Committee was dissolved given the direction the MVCC Committee was taking along with the NCHC s change in governance model. Overview of the Committees Work and Accomplishments The Committee s creation was preceded by a significant financial and operational challenge facing MVCC at the closure of Mount View Care Center ended 2016 with a $1.4 million dollar operational deficit in conjunction with a $624,000 structural deficit built into the adopted 2017 budget. In addition to studying current operations, the Committee exhaustively researched the core policy issue of whether Marathon County should have a nursing home and if so, within what scope and operational guidelines required for viability and quality patient care. The MVCC Committee s work began in earnest in February 2017 being largely driven by Clifton Larson Allen s Operational and Financial Study and Recommendations for MVCC. The report was commissioned, overseen and accepted by the MVCC Committee in Much progress has been made as a result. Over the last year, MVCC has vastly improved employee retention and satisfaction, increased patient satisfaction, improved quality including moving from a 3-Star facility to a 4-Stars, managed without incident a major right-sizing effort, completely eliminated a structural deficit and are operating in 2018 with $200,000 less in County tax levy.

5 Task Force Recommendations Based on the body of the Committee s work there are number of policy recommendations suggested by the MVCC Committee herein. The primary policy consideration of the Committee was whether Marathon County should close, sell or continue to operate MVCC. Consensus has emerged through the process that Marathon County is best served in the foreseeable future by continuing to operate MVCC through an updated Management Agreement with NCHC. Further, the MVCC Committee has the following specific recommendations within their chartered duties and responsibilities: Recommendation #1: Based on the projected community needs, Mount View Care Center services need to include: Long-term care for the protectively placed and vulnerable with complex medical or behavioral health needs who are difficult to care for and are likely not to have access to other nursing homes in Marathon County. A continuum of innovative dementia care services for the protectively placed and vulnerable. Short-term rehabilitation for the medically complex or individuals with a behavioral health diagnosis. Ventilator dependent care for vulnerable residents with medically complex respiratory illness and disease. Recommendation #2: Based on community need and services determined to be of highest value to Marathon County above, MVCC needs to operate a skilled nursing facility with 176 beds and maintain a licensure of 200 beds or less. Bed licenses can be shifted easily between services areas or for the creation of new focused services. For the foreseeable future, licenses should be applied to the following services array: Long-term Care: 16 beds (currently 37 beds) Dementia Care: 96 beds (currently 100 beds) Short-term Rehab: 32 beds (currently 23 beds) Ventilator Care: 32 beds (currently 25 beds) Recommendation #3: The MVCC Committee has established goals with regard to payer mix as outlined in the Mount View Care Center Delivery Matrix (attached). The Committee spent significant time and depth understanding the form and function of payer mix sources in the overall viability and its impact on tax levy support required for ongoing operations. Payer mix performance, including revenues from Medicaid, Medicare and Insurance along with State rates and supplemental payments, can be very dynamic. The policy recommendation is that MVCC is charged in balancing available payer sources in such a way that MVCC can fulfill its mission within the prescribed scope of services listed above while at the same time maintaining or lowering Marathon County s tax levy contribution to operations. Specific payer mix targets are suggested in the Mount View Care Center Delivery Matrix. Tax levy support from Marathon County should be pegged at or below the estimated cost Marathon County would have to pay for protective placement if MVCC was closed or sold. In 2018, the value of this obligation and current tax levy support of Marathon County was approximately $1.5 million dollars. A number of operational performance enhancements to improve payer mix revenues were reviewed and implemented since the Committee s work began.

6 Recommendation #4: The Mount View Care Center Committee recommends that Marathon County make substantial renovations and updates to the MVCC physical plant. These changes are needed because of the age of the building, changing consumer preferences impacting admission volumes and to enhance issues of dignity in care delivery. If these changes are not made, it is highly unlikely MVCC will be a financially viable operation going forward. Ultimately leading to increased County tax levy support for operations and/or an increasing structural operating deficits. Consultants hired to develop a Master Facility Plan and its associated financial implications have concluded a do-nothing approach would be the most costly option if Marathon County is to continue to operate MVCC. Further, the proposed renovation plan does not bind Marathon County in perpetuity to staying in the nursing home business. These renovations would centralize MVCC operations on the NCHC campus and increase the value of the asset for the County. There does not appear to be a strong market for MVCC s sale at this time and the County can best meet its statutory obligations through continued operation of MVCC. Renovations should be done such that the MVCC program units would function in highly adaptable 16-bed neighborhoods. These units could quickly be adapted for other skilled level long-term care or residential services for other populations. Marathon County has the capacity to invest upwards of approximately $25 million with little to no tax levy support projected for debt repayment. Debt for the project could be serviced from enhanced revenue and operational efficiencies discovered during the MVCC Committee study of these and other recommendations. Recommendation #5: The Marathon County Health and Human Services Committee should be the governing and policy oversight body for MVCC going forward. The Health and Human Services committee should regularly monitor survey results, oversee operational and policy changes, monitor financial performance and manage contract performance of through a Management Agreement to operate MVCC with NCHC. The MVCC Committee recommends the County Board give the County Administrator the authority to enter into a new five (5) year Management Agreement with NCHC to manage MVCC. The new Agreement must modernize the current 1998 Management Agreement and provide for specific performance expectations as it relates to: - Employee Retention, Satisfaction and Competency - Scope of Care and Services Provided and Corresponding Admission Criteria - Regulatory Compliance and Quality of Care - Financial Performance, Rates and Collections - Tax Levy and Operating Performance Targets These performance expectations will require regular reporting to and monitoring systems to be established for the Health and Human Services Committee. Quality of care and operational oversight responsibility will remain with the NCHC Board within the performance expectations and authorities defined in the Agreement. With these mechanisms in place, the MVCC Committee recommends that the MVCC Committee would no longer be necessary following the acceptance of this Final Report and Recommendation by the Marathon County Board. Conclusion While these recommendations do not completely reflect the depth or volume of analysis performed by the MVCC Committee, they do summarize in the most succinct fashion the policy actions recommended to be taken. The Marathon County Board is respectfully requested to consider adopting the recommendations contained herein based on the consensus of the Committee Members tasked with forming them on the Board s behalf.