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Challenges in HC Minutes 1-29-14
Minutes FOR MEETING JANUARY 29, 2014

I. Introductions: Present were: Julie Fay, Paddy Moore, Dr. Charles Hodge, Trudy Carter and Kathleen Samways. New to this group is Debbie Dolliver from Greater Boston Health Care, a provider of private care and for Elder Services. Ellen McCabe of Hope Hospice conferenced in by phone.

II.     Meeting minutes of January 6th & December 16th were approved.           

III.    Follow-up to Assignments Last Meeting
                • Sheila:  was to follow-up with MVH Grand Rounds re MOLST. Shelia was not able to make the meeting. We will need to continue this (Ed note: Ellen McCabe is a trained trainer for MOLST).      
                • Kathleen:  Distributed the Rural Scholars data to be used by the Workgroup in crafting direction in planning. See appended slides from RS presentation.       
                •Three priorities for the group will be:
        ï       Service strategies      
        ï       Systems change/models   
        ï       Workforce shortages/development

IV.     Further Develop Work plan Tasks
                • Tabled discussion about age-group definition and preventive programs and the scope of the workgroup.
                • Reviewed the draft of the group-specific work plan.
                • Need to target what details of shortage
                •People - workforce
                • Financial resources.
                • Rules for eligibility under insurances

Discussion: Charlie asked whether the steamship would help survey people going off Island for medical reasons so we could get an idea about WHY they go off-Island (for privacy, to get away, because they can't/won't wait for a specialist to get here, preference for a provider with whom they already have a relationship?) Would PCP doctors be willing to share?

Regarding workforce, Debbie offered that GB are seeing situations where individuals are hired privately who are ëin worse shapeí than the patient.

Regarding the current service system (which includes workforce resources): Paddy asks how important it is to drill deeply into gaps identification. Group feels that it is important to have a handle on at least ball-park nos in order to demonstrate need.

Julie and Kathleen share how payment is secured now (or not).

Can we look at a care plan retrospective and see what arenít being seen due to staff availability? Missed ordered visits? J&K share some details about daily triaging for prioritization. Need to address filling the gaps (which is now accomplished by squeaking) with REAL solutions instead of daily juggling.

Julie shares that there are private practices take care of people who can pay for them, but people with Mass Health must come through clinic - or - if they see a non-physician and needs meds must come through MVCS. This is a confluence of payer, resources, free care if needed.

How can we nudge the responsibility of practitioners to ëgivebackí to the community?

Pvt Practitioners bill per unit $120.00 pays electrical and malpractice, keeps minimal note. Clinic reimbursement is less, documentation time is a stretch.

Emergency services are a contract that has been underwater for years. Barely able to meet need. Children and substance abuse go to the head of the list

Is this a political problem? Where are our politicians?

Could we put pressure on insurance companies for a common-application?Ask them to identify critical shortages and address them with special rules or waivers.

Julie discussed the history of a 'carve-out' of Medicaid benefit and put with private provider. This reduced care cost but also added layers of administration in order to get claims paid.

Discussed patient-centered-ness vs. finance-driven care plans, unserved people. Trudy suggested we add 'contemplation time' around patient as a priority in conversations about reimbursement.

Work plan to include allied health needs assessment, expansion of schematics of needed services (circles). Kathleen will share home care 'circles'.

Add to Work Plan template - 2.5 Hospice services ñ new study says people who use Hospice benefit cost Medicare 50 cents for every dollar spent. Trudy and Ellen will work on hospice flow chart.

V.      New Business/Assignments
                        • Julie will identify wait-list at MVCS.
                        • Kathleen will do VNA  circles
                        • Debbie Dolliver, GBH/ES needs, waitlist.
                        • Trudy and Ellen will do Hospice circles, waitlist.
                        • Charlie will review write-up on improving health care, try to view 'Escape Fire'.
                        • Cindy - Maybe we could survey participants in community groups, people who attended Escape Fire screening in March 2012 for reasons they go off-Island for care?

VI.     Next Meeting
Work plan due now on Feb 28. Group meets again on Feb 3 at 8:30.

Respectfully submitted,Kathleen Samways, DPT, P.T.
Vineyard Nursing Association

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