Overview of Alaska s Hospitals and Nursing Homes. House HSS Committee March 1, 2012

Transcription

1 Overview of Alaska s Hospitals and Nursing Homes House HSS Committee March 1, 2012

2 Alaska Hospital and Nursing Homes Testifying Today Fairbanks Memorial Hospital Mike Powers Central Peninsula Hospital Rick Davis South Peninsula Hospital Robert Letson Petersburg Medical Center Liz Woodyard Wildflower Court Millie Duncan

3 Alaska is Beyond Rural when compared to other States

4 78% of Health Facilities in Alaska have Special Federal Designation

5 Health Care is a Major Employer in Alaska

6 Half of all Health Care Employment is in Hospitals & Nursing Homes

7 Health Care Employment is throughout the State

8 Health Facilities are Impacted by Higher Costs

9 Alaska Costs Compared to Comparison States Alaska s Cost of Living: 30% higher Alaska s Hospital Costs: 38% higher

10 Cost Drivers Impacting the Cost of Care in Alaska

11 Alaska Pays More for Health Care Practitioners than 8 Comparison States

12 The Silver Tsunami

13 Patients Must Travel to Receive Care

14 Hospitals Must Serve All Who Need Care Lost revenue = $410M Total Operating Expenses

15 Fairbanks Memorial Hospital

16 WHO DO WE SERVE - Fairbanks Memorial Hospital Sole community provider for 250,000 sq miles 67% White, 21% AK Native, 12% Other 90% admissions from within 30 mile radius and Native & Military unique relationships Top diagnoses: normal delivery psychoses, alcohol abuse Pneumonia

17 ECONOMIC IMPACT- Fairbanks Memorial Hospital employees 2. Salaries/benefits: $107M 3. Gross revenues: $360M 4. Relentless Capital Campaign 5. 8,000 10,000 employees over the years

18 Fairbanks Memorial Hospital CHALLENGES Niche providers DET Beds Chronic Inebriates Assisted Living Evolving medical practice model Aging surgery facilities High Alaska cost structure Adolescent behavioral health services SOURCES OF PRIDE Community Owned Native partnership Military partnership No deferred maintenance Growing our own -focus on perioperative nursing Physician recruitment Continuum of care Disaster planning

19 GOING FORWARD Fairbanks Physician Integration Continuum of Care improvement Growth in Specialty Services Behavioral Health & A community model The mile wide inch deep challenge 4 yr RNs and increasing certifications

20 Central Peninsula Hospital Soldotna Alaska 49 Bed acute care 8 outpatient clinics 60 bed long term care Planetree affiliated 720 Employees 50 Active Medical Staff (25 Employed MDs)

21 WHO DO WE SERVE Central Peninsula Hospital Kenai Peninsula Borough Residents 37,000 Primary Service Area 50,000 Secondary Service Area Owned by KPB, managed by the Assembly through a Lease Operating Agreement with CPGH, Inc.

22 SOURCES OF PRIDE/SPECIAL CHALLENGES Central Peninsula Hospital Community Owned/Community Pride 25 employed/25 independent physicians Current Challenges Competing entities moving in to break off profitable services Ambulatory Surgery Center Off-site Cancer Center Outpatient Imaging Center

23 GOING FORWARD Central Peninsula Hospital Preparing for Health Care Reform by Clinically Integrating (25 employed physicians) Hardwiring Quality and Patient Satisfaction processes Implementing EHR to hard-wire Quality and Patient Satisfaction processes throughout care continuum Exploring contracting possibilities beyond hospital only services

24 Two Specific Categories of Value Based Purchasing Quality of care Core Measures Patient Satisfaction Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Surveys

25 Core Measures The Centers for Medicare and Medicaid (CMS) developed several measurements to reflect the Quality and Safety of care in hospitals. Pneumonia Surgical care improvement project (SCIP) Heart failure Heart attack (AMI) Obstetrical care Children s Asthma Stroke Vaccination rates

26 Core Measures Current Pay for Performance Pieces Elements of the PN, AMI, HF, and SCIP core measures Perfect Care Score is a composite score of these elements Applicable to Medicare patients Pay for performance is calculated based on compliance with these elements.

27 Why are they important? Reflect evidence based-standardized care Associated with better outcomes Publicly reported Allow systematic comparison of hospitals by consumers. This information is available publicly on Associated with Value Based Purchasing payments

28 Central Peninsula Hospital Perfect Care Scores 100.0% 98.9% 98.4% 94.3% 95.6% 95.6% 98.8% 98.7% 98.8% 98.1% 99.0% 98.0% 90.0% 85.9% 82.8% 82.4% 80.0% 70.0% 66.2% 65.4% 69.6% 67.6% 60.0% 50.0% 47.8% 40.0% Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11

29 Patient Experience Based on HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) How well nurses communicated with patients How well doctors communicated with patients How responsive hospital staff were to patients needs How well caregivers managed patients pain How well caregivers explained patients medications to them How clean and quiet the hospital was How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions) Overall rating of the hospital Publicly reported

30 Strategies to Improve the Patient Experience Review all patient satisfaction data at an administrative level each week. Follow up phone call to address all patient concerns Hourly nursing rounds Management rounds Address specific problem areas Quiet environment

31 Percentage of Patients Rating the Hospital 9 or US AVG AK AVG CPH HCAHPS Score (04/07 to 03/08) HCAHPS Score (10/07 to 09/08) HCAHPS Score (04/08 to 03/09) HCAHPS Score (10/08 to 09/09) HCAHPS Score (04/09 to 03/10) HCAHPS Score (10/09 to 09/10) HCAHPS Score (04/10 to 03/11)

32 Awards and Recognition Received Mountain Pacific Commitment to Quality award in 2008 Received Mountain Pacific Quality achievement awards in 2009, 2010, and Named as the top hospital for CMS core measures compliance in the State of Alaska in Recognized as a Joint Commission Top Performer in 2010 for excellence in key indicators which is the top 14% of hospitals in quality in the nation and the only hospital in Alaska to be recognized.

33 South Peninsula Hospital Homer, Alaska 22 Acute & Skilled Beds 28 Long-Term Care Beds Non-Profit, owned by the Kenai Peninsula Borough 22 Physicians / Orthopedic Clinic 285 employees $16.5 Million in Annual Payroll Acute Care & Swing Bed - Average Daily Census 10 Long-Term Care Average Daily Census 26 29,000+ Outpatients visits per year

34 WHO DO WE SERVE South Kenai Peninsula Service Area 12,700 residents covering 8,317 square miles Remote communities, some accessible by air or water only Russian, Native and Non- Native population Senior Population, growing faster than state and national average Standard payer mix: 33% Medicare; 32% Commercial; 24% Medicaid; 11% Charity/Self Pay

35 ECONOMIC IMPACT- South Peninsula Hospital Payroll of $16.5 million annually Economic multiplier translates to $96 million economic impact Largest employer on the southern peninsula Local vendors and supplies Community benefit

36 SPECIAL CHALLENGES- South Peninsula Hospital Workforce Issues Clinical Staffing (Pharmacists, RN, PT, Lab Techs, Physicians such as Family Practice and Psychiatry) Recruitment difficult in rural setting Mandatory EHR (Electronic Health Records) Penalties, Cost, Burden Aging Population Energy Costs Inconsistent Volumes

37 GOING FORWARD Healthcare Reform Doing more services with less reimbursement Value Based Purchasing / Quality Measures Meaningful Use Physician Alignment Increase of hospital based Outpatient Clinics and Services

38 Critical Access Hospital - CAH Minimum 35 miles to another hospital Rural area Limited bed size 25 or less < 96 hours annual average length of stay 24 hour emergency and nursing services Participate in a rural health network Established credentialing and quality assurance agreements with a fellow hospital

39 Critical Access Hospital - Financials Total Margin 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% -1.00% FY2009 FY2010 FY 2011 Peer Group (2009) SPH Margin Median AK (2009) Paid 101% of Reasonable Cost Total Operating Margin: 2-3% on average

40 Critical Access Hospitals in Alaska 13 hospitals in Alaska designated Critical Access Hospital (48% of Alaska hospitals) Health Strong Index Awards Top 100 Critical Access Hospitals South Peninsula Hospital, Homer Ketchikan General Hospital, Ketchikan Valuable part of Community Economic Engines Charity Care

41 Petersburg Medical Center Non-Profit, owned by the City of Petersburg No financial city support 4 Physicians- Family Practice Clinic 95 Employees and 4 th Largest Employer 9600 Clinic visits per year Acute Care Average Daily Census.75 Long-Term Care Average Daily Census 13 Swing Bed Average Daily Census 3

42 WHO DO WE SERVE - Petersburg Medical Center 12 Acute and Skilled Beds 15 Long-Term Care Beds Population % Decrease in Population from % Decrease in school enrollment 76.7% ages 18 and over 12% ages 65+ Major Industries Commercial Fishing Seafood Processing Government Health Care Leisure and Hospitality

43 Petersburg Medical Center Services Offered: Lab Radiology Physical Therapy In Patient Swing Bed Long Term Care Clinic Wound Care Home Health Chemotherapy Visiting Clinics Eye, Surgery, Orthopedics Services NOT Offered: OB Deliveries ICU Physician Specialists Any Complex Surgical Cases

44 SPECIAL CHALLENGES- Petersburg Medical Center Financial Stability Stable Work Force On-going Capital Improvements Increase Number of Visiting Physician Specialty Clinics

45 Wildflower Court Wildflower Court is a nursing home providing a high level of care for long-term or acute illnesses. The organization is a nonprofit corporation. It is not a part of Bartlett Regional Hospital. Wildflower Court (St. Ann s Nursing Home) admitted it s first resident in November 1977.

46 WHO DO WE SERVE - Wildflower Court Wildflower Court State Average National Average <54 years old 15.3% 7.3% 6.2% years old 15.3% 10.1% 8.5% years old 16.7% 21.6% 14.7% years old 31.9% 28.6% 29.8% 85+ years old 20.8% 32.4% 40.8% Needs assistance or assistive device for ambulation Wildflower Court State Average National Average 16.6% 38.8% 29.9% Requires assistance for eating 22.2% 41.3% 39.4% Needs staff assistance for transfer 35.1% 52.8% 58.6% Dependent on staff for bathing 14.8% 29.1% 34.8% Needs staff assistance for toileting 42.5% 54.9% 57.2% Dependent on staff for dressing 11.1% % A younger population than the state and national averages. A more physically capable population than the state and national averages

47 WHO DO WE SERVE - Wildflower Court Residents receiving specialized rehabilitative services Residents with pressure sores on admission Other LTC 7.9% Wildflower Court State Average National Average 37% 22% 23.7% 7.4% 3.4% 3.6% Deceased 37.0% 66.5% of admissions are for rehabilitation and/or wound care 55.1% are discharged home Home 55.1%

48 ECONOMIC IMPACT- Wildflower Court 105 employees $6.7M in wages and benefits $172,000 in professional contracted services $1M in locally purchased supplies & equipment Licensed for 57 beds Provide services for an average of 100 individuals per year.

49 9 or More Diagnosis 44.6% SPECIAL CHALLENGES- Wildflower Court 2 Diagnosis 0.2% 1 Diagnosis 0.2% 3 Diagnosis 0.5% 4 Diagnosis 2.9% 5 Diagnosis 9.2% 8 Diagnosis 12.9% 6 Diagnosis 13.8% 7 Diagnosis 15.8% Dementia Schizophrenia Complexity of residents conditions Residents with a Mental Health Diagnosis Depression Affective and Other Serious Disorders More than one Mental Health Diagnosis Growing number of residents with mental health diagnosis. Providing quality of life for a relatively young population

50 SOURCES OF PRIDE - Wildflower Court Bronze Quality Award by the American Health Care Association Recipient of My Innerview Excellence in Action Award for ranking in the top 10% of the nation for Staff, Resident, & Family Satisfaction Surveys for two years Recipient of Mountain-Pacific Quality Health s Excellence in Care Award & Quality in Care Award Achieved Milestone 1 of The Path to Mastery : The Art of Creating a Caring Community awarded by The Eden Alternative

51 GOING FORWARD - Wildflower Court Malcolm Baldridge Quality Award Well Workplace Award Employer of Choice Award

52 Nursing Homes: Confronting Today s Challenges Present day nursing homes have evolved, in response to new medical approaches, higher health care cost, and restrictions by payor sources, into a multiple process health care delivery system providing sub-acute care, long term nursing care for the chronically ill, and terminal care for those near the end of life.

53 Nursing Homes: Confronting Today s Challenges Quality of Life Mental Health - Complex Behaviors Collaborative Treating Acute Conditions in the Nursing Home rather than Hospitalizing the Resident

54 Questions?