Minutes Maricopa Health Centers Governing Council General Meeting Maricopa Medical Center Administration Building, Auditorium 1 & 2 November 1, 2017 6:00 p.m. Voting Members Present: Liz McCarty, Chair Melissa Kotrys, Vice Chair Gary Tenney, Treasurer Lloyd Asato, Member Terry Benelli, Member participated telephonically Christine Hammond, Member April Jordan-Kramer, Member Julie Roberts, Member participated telephonically at 6:16 p.m., disconnected at 7:56 p.m. Rose Rubio, Member participated telephonically at 6:05 p.m. Eileen Sullivan, Member Ryan Winkle, Member participated telephonically, disconnected at 6:54 p.m. Voting Members Absent: Scott Jacobson, Member Others/Guest Presenters: Melanie Talbot, Chief Governance Officer Steve Purves, President & Chief Executive Officer Kris Gaw, Chief Operating Officer Martin Demos, General Counsel Barbara Harding, Chief Executive Officer, Maricopa Health Centers Governing Council Susan Gerard, District Board Director arrived at 6:12 p.m. Abraham Kuruvilla, M.D., Chair Department of Family & Community Medicine Medical Director participated telephonically Liliana Orta, Director of Patient Access Recorded by: Pam Hjerpe, Secretary Maricopa Health Centers Governing Council Call to Order Chairman McCarty called the meeting to order at 6:02 p.m. Roll Call Ms. Hjerpe called roll. Following roll call, Ms. Hjerpe announced that there were nine of the twelve voting members of the Maricopa Health Centers Governing Council present, representing a quorum. Ms. Rubio and Ms. Roberts joined telephonically shortly after roll call. For the benefit of all participants, Ms. Hjerpe named the individuals present in the meeting room as well as those participating telephonically.
Call to the Public Chairman McCarty asked if any speaker s slips were turned in or if anyone from the public wished to address the Council. There were no comments from the public. General Session, Presentation, Discussion and Action: 1. Approval of the Consent agenda a. Approve the Maricopa Health Centers Governing Council Meeting Minutes dated October 4, 2017 b. Accept the Recommendations from the Maricopa Health Centers Governing Council s Executive Committee to Approve the Maricopa Health Centers Governing Council Mileage Policy c. Accept the Recommendations from the Maricopa Health Centers Governing Council s Executive Committee to Approve the Maricopa Health Centers Governing Council Travel and Travel Expense Reimbursement Policy MOTION: Ms. Kotrys moved to approve the consent agenda. Ms. Hammond Seconded. Motion passed by voice vote. MOTION: Chairman McCarty moved to recess general session and convene in executive session at 6:05 p.m. Ms. Jordan-Kramer seconded. Motion passed by voice vote. Chairman McCarty reconvened the general session at 6:39 p.m. General Session, Presentation, Discussion and Action: 2. Maricopa Health Centers Governing Council s Chief Executive Officer s Report Including but not limited to the Scheduling Template and the Hours of Service at the Federally Qualified Health Centers Look Alike Clinics Ms. Harding noted this is a continuation of the previous discussion on the clinics production in revenue capture and the wellness of the citizens in the Maricopa County. The quadruple aim is to improve access to care and efficiency, reduce costs and increase revenue, and to improve patient and physician satisfaction. Ms. Harding reviewed the clinic hours, stating it is important to have the clinic hours meet the patient needs. She noted the hours for the clinics vary; most of the clinics are Monday through Friday, opening at 7-7:30a.m. and closing at 5-5:15 p.m. A few of the Family Health Centers (FHC) participate in evening hours and five of the FHCs have weekend hours. Ms. Hammond asked if the last appointment of the day was at 5:15 p.m. or is that the time when the doors close. Ms. Harding responded that is when the doors close, however the staff will finish with the patients they have. She reviewed the appointment types for family practice; Same Day Appointments are when patients will be scheduled for the same day they call in. Open Access Appointments are appointments made the same day, the next day or within a week. The Traditional Appointment, which is a pre-scheduled appointment. Most family practice departments incorporate all the appointment types in their templates. The same day appointments are the highest at the Seventh Avenue FHC, they eliminated the pre-scheduled appointments. The most common appointment is the traditional or pre-scheduled. She noted that Pediatrics use the pre-scheduled visits, Internal Medicine and Obstetrics (OB) do not use the Open Access model, they use the same day or pre-scheduled appointments. 2
General Session, Presentation, Discussion and Action (cont.): 2. Maricopa Health Centers Governing Council s Chief Executive Officer s Report Including but not limited to the Scheduling Template and the Hours of Service at the Federally Qualified Health Centers Look Alike Clinics (cont.) Ms. Orta added that the call center volume at 7:30 a.m. is high and it would be extremely hard to get a Same Day appointment for OB, that is the highest call volume time for OB, Pediatrics and Internal Medicine. Ms. Gerard inquired: would it not be considered same day if an established patient calls to make an appointment that day because they are sick, wouldn t that patient be a priority. Ms. Orta responded every call is treated the same that calls for services. The call center employees are not clinical and cannot make a decision if the patient needs to be seen that day. Ms. Gaw added this is the current method, Ms. Harding is in the process of changing this process moving forward. Dr. Kuruvilla pointed out the call from a sick patient should be transferred to the nurse who can triage the patient and decide whether or not to give them an appointment for that day. Ms. Harding continued she would like to broaden the scope of appointments to have a better opportunity to address the patient s needs. She added that the top three appointments made through MyChart are in the Comprehensive Health Center (CHC) Family Practice, Avondale FHC and Sunnyslope FHC. Mr. Tenney inquired as to why those three are at the top of MyChart appointments. Ms. Harding responded that the majority of patients seen at the CHC Family Practice are MIHS employees. Ms. Gaw added that Avondale and Sunnyslope managers are making an effort to increase the usage of MyChart as part of their action plan. Mr. Tenney asked if there was any data on the no show rate in MyChart appointments versus the call in s. He wanted to know if the 28% no show rate has a correlation with MyChart patients. Ms. Kotrys asked if the standardize practice was used at all the clinics, if the volumes change. Ms. Orta responded it would be less complicated to schedule a patient, making appointments for next week or within a few days. Ms. Harding added she is establishing an Access to Care Performance Improvement Group. The group will address the scheduling, and referrals, implement a pilot program for no show and overbooking, recruit and fill budgeted Medical Assistant (MA) positions, address the provider clinic coverage, evaluate outcomes, barriers and accomplishments, and implement system improvement changes across all the ambulatory clinics. Dr. Kuruvilla added there would be a learning curve for the patients to use same day appointment as opposed to the traditional pre-scheduled appointment, which would take about six months to implement the practice. Ms. Harding added the challenge with moving towards open access is the increase volumes for the call centers and the ability to accommodate the patient needs. The comprise will help with an even distribution of open access, same day and pre-scheduled appointments. Ms. Kotrys inquired on the transition goal, is it from the current scheduling format to the standardize template. 3
General Session, Presentation, Discussion and Action (cont.): 2. Maricopa Health Centers Governing Council s Chief Executive Officer s Report Including but not limited to the Scheduling Template and the Hours of Service at the Federally Qualified Health Centers Look Alike Clinics (cont.) Ms. Harding responded with an example, a pediatric specialty appointment standardize template would be 22 appointments. Same day openings - 4, open access -6 appointment slots, 4 appointment slots for 30 minute appointments, 6 established appointments and 2 appointment slots for Early and Periodic Screening, Diagnostic and Treatments patients. Mr. Purves asked that under the current template, would a patient be given an option to be seen that day. In addition, he asked if it really takes three to six months to manage these patients into a new system, he believes the patient satisfaction experience would drop dramatically if it took three to six months for a new system. Ms. Harding responded that to convert to full open access takes about three months. The open access population wants immediate gratification and this works well for them. For patients that had a prescribed routine, open access is a problem for them. The chronic disease patients need the traditional appointment as well as the non-compliant patient. She does not prescribe to go to full open access, as it does not meet every patient s needs. Ms. Gaw would like to implement a Say Yes Campaign, to accommodate all the patient s needs. The study on the call center will support the campaign. Dr. Kuruvilla suggested that patient education would go a long way in curbing the no show rate with the same day or open access appointments. Mr. Tenney asked why is there such a resistant s with the providers on same day or open access appointments. Dr. Kuruvilla responded the provider would prefer having the same day access than over booking. Ms. Gerard asked for an explanation on patient follow up care, if a patient is seen today and told to follow up in 10 days can that patient leave the clinic with a scheduled appointment. Also is there a way to notify a patient by texting they have a future appointment or a reminder of an appointment. Ms. Gaw responded that the only way the patient would leave with a future 10 day follow up appointment is if there were open traditional slots available under the current template, if not the patient would be told to call and make that appointment. Ms. Orta replied there is a pilot program at Avondale on texting patients and their no show rate has decreased. She added there are limitations to texting; the Avondale pilot program is also utilizing calling the patients as a reminder. Patients that use MyChart will get a reminder via the patients e-mail. Ms. Gaw pointed out there is a limitation with MyChart, not everybody can make appointments on MyChart. Appointments are not available for all the providers; there are restrictions that are being worked through to make appointments. Historically the templates are provider-based decisions. Maricopa Integrated Health System (MIHS) is working with the providers through the dyads to make it a collective approach to how this can work. Ms. Harding made a few announcements; on October 22 there was an AIDS walk, with a team of 15 walkers from the McDowell Clinic who raised over $1,500. There are two future events on November 18; the Glendale Health Fair, and the food pantry, which will be on the main campus, all volunteers are welcome. There are project improvements and initiatives on the signage at the FHC s for compliance and patient communication. The 1 st Episode is moving from Pendergast to the Avondale FHC. The regulatory compliance Patient-Centered Medical Home (PCMH) recertification is in process, current certifications ends on May 2018. As a reminder, the Health Resources & Services Administration onsite survey is August 28-30, 2018. Ms. Harding is in the process of calling the Council members, to ask about the health concerns of the community you represent and your priorities you would like to see addressed by the Federally Qualified Health Centers Look Alike Clinics in the coming year. 4
General Session, Presentation, Discussion and Action (cont.): 3. Maricopa Health Centers Governing Council (MHCGC) Committee Reports a. Compliance and Quality Committee b. Executive Committee c. Finance Committee d. Membership Committee e. Strategic Planning and Outreach Committee Ms. Rubio noted the Compliance and Quality Committee had a meeting two months ago. Vice Chairman Kotrys noted the Executive Committee has been focusing on governance. The Governing Council voted on a new mileage policy and travel policy on the recommendations from the Executive Committee. Mr. Tenney stated the Finance Committee reviewed the quarterly downstream revenue reports; the downstream revenue is the encounters sent from an FHC to the specialty services at the Comprehensive Health Center, lab or imaging departments. He added from April 1, 2016 through March 31, 2017 there were 80,000 encounters, which equates to $52 M in contribution. Ms. Jordan-Kramer noted the Strategic Planning and Outreach Committee met in October and reviewed the previous quarter s outreach events and upcoming events. 4. Report on the 2017 National Association of Community Health Center s (NACHC) Conference Ms. Sullivan thanked the Council for giving her the opportunity to attend the National Association of Community Health Centers conference. The boot camp was extremely informative for new council members. She suggested the Council send more than one Council member at a time to this very informative conference. She added Ms. Talbot was extremely helpful and easy to work with on arranging the travel for her. She was surprised to meet people from other cities that are cognizant of MIHS. 5. Maricopa Integrated Health System s President and Chief Executive Officer s Report Mr. Purves noted Maricopa Integrated Health System is above budget according to the September financials. There will be merit recognition for the employees coming up soon. He noted MIHS is recognized by many healthcare systems, mainly due to our financial turnaround of over $80M. There were seven completed community engagement meetings. A groundbreaking ceremony will be scheduled for the West Valley Primary Care and Specialty Center in the near future. Ms. Hammond added that the community engagement meeting she attended was done professionally, the staff had positive attitudes and answered community questions. She complimented the staff on a job well done. It was a great experience for the community. Mr. Purves noted the Leapfrog hospital-rating score, MIHS received a D rating, which was expected. Leapfrog is a hospital safety scorecard and assigns a letter grade to hospitals measures on the Centers for Medicare and Medicaid Services (CMS). Leapfrog is one of a number of organizations that provides reports and rankings of hospital performance. These organizations use different quality measures, performance data and methodologies to calculate scores. As a result, a hospital may perform well on one report card and poorly on another. There have been many changes in the MIHS Quality Improvement (QI) department, changes in the quality and the quality process. The position that over sees the QI department has been upgraded to a Vice President level and reports to the Chief Nursing Officer. 5