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Challenges in HC Minutes 1-6-14


Present:  Trudy Carter, Julie Fay, Paddy Moore, Kathleen Samways, Judy Sheila Shapiro.
Absent:  Cindy Doyle, Joy Ganapol, Charlie Hodge, Ed McGonagle, Susan Mercier, Grace Sullivan.

I.      Approval of December 16th Meeting Summary was postponed to next meeting.

II.     Issues Raised at last meeting re priority of issues for workplan:
1.    Definition of target population: Trudy raised question, and there was a sprightly discussion re at what age to put lower age cutoff.  Age 50? 55? 65?  Kathleen pointed out that a functional definition is one way to go, and it would include the disabled  population who are eligible for many of the same services we are concerned with. Decision: Weíll continue to look for sample definitions that might bridge these gaps, and it will also be referred to the Coordinating Committee.

2.    Data about major needs ñ We reconfirmed that weíll use the Rural Scholar report data on population (which has been vetted again by the Donahue Institute at U Mass) and the incidence data.  Kathleen will make copies for the next meeting.  

3.    Follow-up to Prior Questions Raised:
        Goal is to reduce ER usage and delays in getting PCP coverage.
        ï Re use of retired nurses: Paddy reported that Dedie Weiler had checked with Nursing director at MVH about nurse availability, and that if they had staff vacancies, they would more than happy to consider retired nurses on island who might be interested.  Further discussions would be needed to develop a pool of nurses willing and qualified to work on a per diem basis.
Paddy also reported that Jay Ferriter, MVH Physician Practice Manager, has expressed willingness to join this group.
        ï  Re possible use of retired physicians:  
                # Sheila reported that she had heard that some states pay for malpractice insurance for physicians who provide to most needy populations, which might address one concern. Sheila will investigate further re Massachusetts policy in funding.
        ï  Would an urgent care and/or “roving clinic” model work on island, possibly providing more care at lower cost?
        ï  Can there be better use of the Drop-in Clinic (Doctors Jacob and Yukevich) and of the Rural Health Clinic in Edgartown?
  • Could the MVH  PCPs make better use of physician extenders, other members of health care teams?  Greater use of Physician Assistants?  Upgrading/expanding use of Nurse Practitioners, giving them more responsibility for patient care?
  • Is there a possible role for volunteers in this area?  We discussed several barriers, including insurance coverage; (need to find out how Hospice and VVH cover their volunteers); process for recruiting volunteers; CORI checks; training; and supervision.  Agreed there would be lots of possibilities, but not an easy solution. A Timebank for volunteer hours may be part of a solution, and Kathleen identified several models in Rhode Island and NYC. Further detailed information is needed.  
  • This led to discussion of shortages in Allied Health professionals such as PT, OT, Speech Therapists, Rehab therapists, and Mental Health and Social Service staff.  We need to document these shortages among the existing agencies.  
Decisions:  We need to:
        ï  Collect data on waiting lists for access to PCPs at hospital and in other physician practices on island.
        ï  Discover hospital projections for optimal physician staffing, now and in response to projected population growth in next 5-10 years.
        ï  Research different models for providing care through teams (use of physician extenders and others) including cost projections if possible.  
III.  Priorities for Workplan:  Paddy noted we seem to have identified three major priorities ñ one re gaps in services, one re workforce shortages, and one re needed system changes in health care delivery.
1.  Re Gaps in Services, we discussed using the circles format to identify both available services and the gaps. Kathleen volunteered to develop one showing gaps in visiting nurse/home care services.
        Also discussion of shortages in on-island specialties and questions to be answered:  
        ï   Is it ok to meet the shortage by referrals to off-island specialists at MGH and elsewhere?  
        ï  Re measuring needs:  What % of population over 65 will need X? % over 85?
        ï   Re specialties, can we identify which specialties are currently available on island (such as podiatry, dermatology)?  What are the wait lists or length of time to get an appointment for those?  What about Alzheimer care?

2  . Re Workforce development as a priority for the group. (See discussion above.)
ï Long term Training possibilities, through programs at MV high school and articulation with Cape Cod Community College. Paddy also mentioned that Bridgewater University is now developing a specialty in health care that might be promising.
ï  Mentoring of new providers by seasoned and/or semi-retired professionals could also be helpful.
There was some talk about how could living-assistance services be delivered to roommates or housemates. Decided to defer to Living in Community group, which is exploring assisted living and nursing home programs.
        ï  Someone asked whether we need to map shortage areas? The conclusion was Yes, because: 1)  real data enables us to apply for funding if necessary; 2) if we figure out where there are gaps in services, we are likely to find they are due to workforce shortages; and 3)  we can identify other barriers to service, which may include limitations on income eligibility, information about availability, or other access issues.

IV.  Other Discussion
1.  There was a discussion about whether it would be helpful to add others to the Committee.  Kathleen strongly recommended Ellen McCabe, from Hope Hospice; Paddy noted that Ellen had signed up originally but there had not been follow-up. She will be contacted.

2.  There was a brief discussion noting that the new Massachusetts regulations regarding MOLST (re end of life wishes) went into effect on January 1st.  Group agreed it would be helpful to have an MVH Grand Rounds so all hospital physicians and other staff would know about the new regs and new forms.  Sheila agreed to talk with Dr. Silberstein to see when such a presentation could be scheduled.


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