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Challenges in HC Minutes 12-2-13
Healthy Aging Task Force  
Healthcare Challenges Work Group
12/2/13
Present:   Trudy Carter, Cindy Doyle, Julie Fay, Joy Ganapol, Charles Hodge, Paddy Moore, Kathleen Samways, Sheila Shapiro, Grace Sullivan.

Guests:  Judy Crawford and Dedie Wieler, MVH Patient and Families Advisory Committee.

Next Meeting: December 16, 3 pm ñ 5 pm MVCS Board Room

Agenda:

1. Introductions

2. Charge (attached)

3. Template for HATF Work Groups (attached), Structure, and Timetable

4. Presentation of MV Hospital Patient and Family Advisory Council ñ Dedie Wieler and Judy Crawford, Co-Chairs

5.  Work Plan

I.  Introductions

Cindy Doyle  - MV Donors Collaborative Board that sponsored DCHC Rural Scholarsí  Project on Healthy Aging

Charles Hodge - Retired MD living on the Island who has experienced frustration accessing medical care on the Island and in trying to offer his services as a volunteer health care provider.  Interested in web-based resources for health care information and services.  

Trudy Carter - Social Worker, Hospice. Interested in promoting better coordination/collaboration of health-care services, overcoming competitive impulses, and in utilizing aging semi-retired health care professionals as a work force resource.

Joy Ganapol - Director of MVCS CORE Program and Program for Children and Families. Interested in finding solutions to medical reimbursement challenges (Currently Medicare and insurers don't reimburse for in-home care services).

Sheila Shapiro - Retired child therapist. Concerned with addiction services and kids.  Interested in holes in the health care delivery system on MV and finding ways that agencies can work together.

Judy Crawford - community representative to the MV Hospital Patient and Family Advisory Council and YMCA Board member (soon to be Board Chair). Interested in promoting the Y's outreach to the aging population and facilitating collaboration among agencies, especially those serving the Islandís senior population.

Dedie Wieler - Chief Quality Control Officer at MV Hospital and Co-Chair of the Patient and Family Advisory Council. Pediatric Nurse Practitioner. She will be retiring in December.  MV Hospital is working to improve health care services to the Island.

Grace Sullivan - Retired Nurse Practitioner with a masters degree in Gerontology who taught at U Mass Lowell and is interested in bringing training programs for health care workers to the Island. Grace couldnít find part time work on the Island so commuted to UMass Worcester and Brigham and Womenís Occupational Health Department.

Kathleen Samways - VNA Clinical Director. Interested in creating and maximizing connections across boundaries between health care providers, and exploring better  access to federal and other national funding for integrated health care services.

Paddy Moore - Mediator who has facilitated national health care discussions related to Health Care Coverage for the Uninsured and the development of the Affordable Care Act. Asked by the Institute of Medicine to facilitate the organization of the national  Eldercare Work Force Alliance.  As the wife of a recently diagnosed Alzheimers patient, she is interested in systemic changes that will encourage greater collaboration among health and human services providers, and a more patient-centric health care delivery system

Julie Fay - Executive Director of MVCS.  (Interests to be explored in next meeting.)

Several points for Workgroup to consider as we go:
        • Is there a way to better utilize the experience and expertise of retirees (such as Charlie Hodge and Grace Sullivan) on a part-time basis in various areas of the Vineyards health care system?
        • Is there something advocates could do to assist agencies such as MVCS and VNA in obtaining reimbursement for in-home services?

II.   Charge to the Workgroup - attached - Work of the Healthy Aging Task Force, and of each of its workgroups, is designed to be aligned with the Dukes County Health Councilís mission. Open meeting laws require meeting times/dates be posted on the County website along with meeting summaries.

III.  Template, Structure, and Timetable

        •  Structure: The HATF exists as a committee of the Dukes County Health Council.  There is a HATF Coordinating Committee, on which all the Workgroups have a representative, whose job it is to provide guidance, assure coordination and integration of efforts, prevent duplication, and be responsible for cross-cutting areas such as cultural competence and workforce development.

        • Template - attached.  Work groups need to develop work plans and present those to the Coordinating Committee by Feb 15.   Included in the plan should be a statement of priorities (among the issues listed in the charge); an inventory of existing services; identification of major service gaps; identification of additional needs; an exploration of other models/programs developed by other communities; and proposed next steps ñ both short term and long-term..

        • Timetable - HATF assumes both a short-term and long-term timetable.  By Feb. 15th each Workgroup will have submitted an initial workplan, describing priority actions for the coming year (2014).  It is assumed that some of the needed actions will take place over a two-three year period.

IV.  Presentation by Dedie Wieler and Judy Crawford on Hospital

Paddy introduced the presentation by thanking Dedie and Judy for agreeing to meet with the Workgroup.  We see the hospital as key to healthy aging on the island, and to the success of the HATF efforts, and we look forward to working with the MV Hospital and Partners.  The first step is finding out what their strategic plans are related to providing health care services to the senior population.

Dedie Wieler

Dedie gave an overview of what the hospital is currently doing, what they plan to do, and next steps.

The hospital is continuing its efforts to attract primary care (PCPs) physicians. They currently have 8 on staff (up from 4). In addition to office hours, the PCís are required to rotate being “on call” in the hospital.  There is one Hospitalist (a doctor who provides primary care coverage in the hospital) on duty Mondays - Fridays.   The hospitalís PCís now spend 15% - 17% of their time in the hospital doing rounds, which dilutes the time they have available for seeing island patients.  Currently each of the PCs is at capacity and/or has waiting lists.  The hospital is looking for full- time (7 days/week) hospitalist coverage to free up PCís so they can take on more patients.  

She described the physician specialists now on-staff at the hospital:

        • 2 orthopedic surgeons;

        •  2 OB-GYN doctors plus 2 nurse-midwives, who together handle 150 births a year .  This is approximately half the volume of what an off-island practice        andles. The MVH OB-GYN department loses money.

        • Dental Clinic:  MVH has offered this service for 8 years; the clinic takes patients with Mass Health coverage,  - has a waiting list, and loses money.

        •  Dialysis Service:  Clearly is a much-needed service, and it loses money.

        • Emergency Department: is very busy, and makes money.

MVH has been given the designation of a Critical Access Hospital (because we are an island, with limited accessibility to mainland services).  As such, the MVH license is capped at 25 beds - including maternity and pediatric beds.  The hospital also is permitted to have a Swing-Bed Program ñ which means that beds can be used for either acute care or skilled nursing as the demand requires.  This Swing Bed Program is required for the hospital to keep its rural access designation, and allows the hospital to make money in this area.

MVH does not provide psychiatric services, and there is no psych nurse on staff,  although there is one psychiatrist in private practice who is also on hospital staff.   Coverage for psychiatric cases is provided in the Emergency Department by MVCS Emergency Services staff.

Physician specialists from off- Island who provide on-island services include:  

        • Cardiologist ñ Dr. Timothy Guiney

        • Dermatologist ñ Dr. Michael Bigby

        • Urologist -

        •  New MGH oncology unit also providing chemotherapy services for island patients.

        * No Neurologist

The new hospital has created an office suite for visiting physicians in the outpatient building.  Veteranís Administration doctor comes monthly to see patients in that suite.

Judy Crawford described her work with the Family and Patient Advisory Council, which she and Dedie co-chair.

        •  There are 4 community members and 4 staff members. Staff members include an RN, a case manager, a patient advocate, and chief of Quality Improvement. For the initial community members, Dedie asked hospital doctors and staff to recommend patients who made suggestions, who were interested in the hospital and health broadly, and who would be willing to speak their minds. The Council meets 4 x a year, occasionally more frequently if needed.  

        •  Initially they have reviewed a different hospital department each time, starting with the ED. Their focus in the ED was to reduce patientsí waiting time (which they have done, cutting it by hours by having certain records taken actually in the patient room, rather than outside in the waiting room.

        • Since their inception, they have reviewed many departments, including the Acute unit;  Patient Advocacy (Here they developed an information sheet giving every patient the Patient Advocateís name and phone number, which is also posted in every patient room.);  Maternity; Volunteers; and they encouraged new oncology unit, as well as out-patient infusion.

        •  In 2014, Council will examine and make recommendations for Ambulatory Surgery; Case management; Pain Clinic; High Risk Care Management; and Rehabilitation and Wellness unit.  

Workforce Training ñ Doctor and nurse specialists canít work in other units.  Only ICU and ED staff are cross-trained so they can float between those two departments.

EMR:  In response to a question, Dedie discussed the present situation with  Electronic Medical Records.  Presently MVH is adapting their current EMR system ñ Meditech - to be compatible with Partners EPIC, which Partners uses at all their hospitals.  MV Hospital will transfer to EPIC in the next four- five years. At the present moment, it is not possible to share medical records with MVCS or VNA, which are on different systems. However, EPIC is proprietary, and some physicians can get access through the Physician Gateway.  

Dedie noted that - contrary to a number of assumptions - Partners does not subsidize MVH. Rather, MVH pays fees for any services they receive from the larger system.

Questions from the Workgroup for the hospital:
        •  Might it be possible to match available MV volunteers with MVH needs? For example, is there a way to use nurse practitioners who would want to volunteer or work part time?  (Discuss per diem needs?)

        •  Is it possible for hospital to develop more flexibility, through the use of cross-training of staff (particularly nurses)?

        •  Does the Advisory Council have access to data to define the problems they solve? Can they be guided by internal hospital data re problem areas?

        • What does the hospital identify as unmet needs?  Are there ways this group can help to address the needs that have been identified ?

Dedie Wieler and Jay Ferriter are the hospital contacts for concerns.


V.  Work Plan:
The group began to identify Priorities and the discussion seemed to focus on identifying service gaps, with lots of ideas for meeting those gaps.

Among the issues mentioned were the following:  Workforce Development; recruitment of specialists; Lack of psychiatric in-patient services; Lack of on-island detox capacity; In home Care -- how to pay for or use of volunteers for visiting; Diversity (or lack thereof); Ways to use highly trained people who only want to work 10 hours a week;  Offer ongoing courses for home health care workers at ACE-  MV-- could be sponsored by VNA or Vineyard Village at Home rather than the hospital;  High School Health Care Assistants Program;  High School/Cape Cod Community College;  Volunteers for friendly visiting.

Homework:

        • Review the Workgroup Charge (attached) and the requested template (attached), and think about what you think are the priority areas for this group to address in the short run and long run.  

        •  What data do we need?  (such as how many people go off-island for care?)

        •  Are there other models we should consider?

        •  What  actions might be appropriate for us to take in working with the responsible agencies?

Grace wants to look into what training is available for people interested in becoming a Home Health aide or CNA nurses training

Attachments/Links:
HATF Mission Statement
Work Group Charge
HATF Challenges Working Group Charge
Template for HATF Work Groups
MV Hospitalís Patient and Family Advisory Council Work Plan
Diagrams of Services Needed to Provide an Integrated Substance Abuse and Mental Health Services on MV
Better to Best: Elements to Achieve Accountable Care



RESOURCES FOR HEALTHY AGING TASK FORCE

Prepared by Grace Sullivan


  • The Patient Protection and Affordable Care Act (part one of the Health Reform Act)

  • Health Care and Education Reconciliation Act (part two of the Health Reform Act)
  •         url: www.healthcare.gov  974 pages PDF
3.Better to Best: Value-Driving Elements of the Patient-Centered Medical Home and Accountable Care Organizations
        a. url: www.pcpcc.org/guide/better-best 46 pages PDF

4.Managing Populations, Maximizing Technology: Population Health Management in the Medical Home

5.Coordination Care in the Medical Neighborhood:Critical Components and Available Mechanisms (AHRQ)    Url: pcpcc.org/resource/coordinating-care-medical-neighborhood



 
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