Southwest Virginia Health Authority – pursuing continuous ...



ACCESS WORKGROUP RECOMMENDATIONSAccess Workgroup provide their findings based upon the original documents provided and the supplemental documents provided as “answers to additional questions submitted by the Committee, and from interviews held with representatives from MSHS and Wellmont healthcare systems during the most recent SWVHA meeting. In addition the Chairs of the Access Committee and the Quality Committee held interviews with the representatives of MSHS and Wellmont prior to the Committee meeting and reported on the answers received. In order for the Healthcare Access Work Group to make recommendations to the SWVHA, the Committee must weigh the benefits of the enhancement of access to the hospital and hospital-related care, including mental health services and treatment of substance abuse, that will be provided to citizens served by the Authority and must make a determination if the anticipated result is improved patient access and satisfaction and to determine if the advantages outweigh the disadvantages regarding healthcare access.Therefore, in order to assure the advantages and patient satisfaction outweigh the disadvantages the Access Committee believes that “NEWCO”(or Wellmont and Mountain States) should commit to the following:1.The following emergent patient care services should exist as a minimum of services offered in each rural facility where current community hospitals exist (and in Lee County): a.Emergency Room and Trauma Services staffed for emergent care including a physician and appropriate staff. (The establishment of an urgent care is not equivocal to these services).b.Laboratory services, Radiologic Services, and basic diagnostic services for patients seen on an emergent basis; as well as those seen for other primary care clinical services.(Radiology, CT, mammography, ultrasound, etc.)g.Emergency Care treatment for trauma, stroke, cardiac care, and critical care services with stabilizations and treatment and communication to the tertiary care centers where patients will be transported i.Dependable Emergency Transport Services between the rural community and the tertiary care center with skilled providers – (eg. paramedic) rather than a volunteer service..2.Improved primary care and prevention programs that decrease the need for inpatient services (over time). The workgroup believes at a minimum the application should include a commitment to improved access to primary care, preventive services, and health maintenance services in all areas where current acute care facilities exist to including (but not limited to):a.Primary Care Services:i.Routine Prenatal Care available, even if those women will deliver in a larger facility. This may be done with primary care physicians or OB/GYN.ii.Primary Care Physician services to include family medicine, or internal medicine and pediatric physicians in order to provide routine primary healthcare, chronic disease management, and health maintenance.b.Specialty care brought to the community for patients who have difficulty in travel by employing specialists or providing specialty care consults in the community (in person or through telemedicine). Areas of interest include but are not limited to:i.Cancer care specialistsii.Cardiologyiii.Pulmonologyiv.Neurologyv.Nephrology (with possible dialysis services in the hospital to be offered on a rotating basis)vi.Psychiatric and Counselling services, especially for substance abuse community based programsvii.Other services available through a hub and spoke model c.Cancer preventions services to include but not limited to:i.Mammogramsii.Colonoscopyiii.New cancer diagnostic screening services as they become the standard iv.Cancer prevention educationd.Other preventive services and programs for the regions most common illnessesi.Smoking Cessationii.Obesity prevention and nutrition servicesiii.Substance abuse prevention and treatment programsa. educating citizens and youth on substance abuse preventionb.educating and standardizing physician practices to prevent poor prescribing habits and on substance abuse screening servicesc.assuring the emergency room practices of NEWCO follow prescribing practices that prevent substance abuse and that the providers are prepared to offer treatment for the acute problems seen from substance abuse d.mental health early identification and mental health treatment programse.wellness programs targeted for the community and region based upon the epidemiologic findings from the research NEWCO will provide and from ongoing research of the services described.e.Chronic Disease Management Programs that prevent hospitalization or repeated hospitalization i.CHF and COPD – prevention of exacerbationii.Diabetes Managementiii.Cardiac rehabilitationiv.Nephrology and dialysis services v.Endocrinology (considering the incidence of obesity and diabetes in the region)f.A Geriatric care program that includes prevention and chronic disease management so patients may be allowed to stay in their home and community g.Hospice servicesh.Other services as need presents from community assessments3.The Access Workgroup believes that as a healthcare workforce is difficult to recruit and maintain in Southwest Virginia, and that NEWCO should commit to maintaining the clinical experiences for the region’s health education programs that currently exist in Southwest Virginia, including:a.medical residencies for physiciansb.osteopathic and allopathic medical student clinical education programsc.physical therapy student clinical education programsd.pharmacy clinical education programse.physician assistant education programs f.nursing student education programs and advanced nursing education programs. g.social work and psychology clinical education programsThe Workgroup believes the programs must be maintained in Virginia and not just the positions maintained within the system or Southwest Virginia’s Access to healthcare will deteriorate.4.The Access Workgroup believes NEWCO should commit to working with the community providers including individual providers, federally qualified health centers and rural health clinics, free clinics, community service boards and health departments. NEWCO is committed in the application to an “open system” that will support and enhance these community based practices through EMR and other means. The commitment to this “open system” should be a requirement, to work with other community providers, and to not limit facilities to employed providers.5.NEWCO has voiced one reason for the application is to transition the current rural hospital to a model that will be sustainable as care continues to transition to community based and outpatient care models. NEWCO should commit to successful models of care they have used or are planning to use to provide and enhance community based care and outpatient care.6.An agreement to continually work to research and revise those services provided to Southwest Virginia to assure access. QUALITY WORKGROUP RECOMMENDATIONSThe Quality Workgroup provides their findings based upon the original documents provided and the supplemental documents provided as “answers to additional questions submitted by the Committee, and from interviews held with representatives of MSHS and Wellmont during the most recent SWVHA meeting. In addition the Chairs of the Access Committee and the Quality Committee held interviews with the representatives of MSHS and Wellmont prior to the Committee meeting and reported on the answers received. In order for the Healthcare Quality Work Group to make recommendations to the SWVHA, the Committee must weigh the benefits of the enhancement of quality to the hospital and hospital-related care, including mental health services and treatment of substance abuse, that will be provided to citizens served by the Authority and must make a determination if the anticipated result is improved quality of care and satisfaction and to determine if the advantages outweigh the disadvantages regarding healthcare quality.The Quality Workgroup of the SWVHA recommends to the SWVHA that the merger should be approved if (and only if) the following assurances for quality improvement are included in the agreement. Note:Assurances in many of these areas were not included in the original application but were introduced in the answers to additional questions and through interviews. In order to assure the benefits of the enhancement of quality by the hospitals and the NEWCO system for ambulatory and hospital-related care, including mental health services and treatment of substance abuse, the Quality Access Group believes the following services must be agreed to by NEWCO. 1.The establishment of the EMR for tracking quality measures in all NEWCO owned facilities and physician practices within the first year of operation.a.To provide a plan for incorporating community based physician data into research and to community based data important quality improvement utilizing the EMR and to implement this plan within the first three years2.To track and publish outcomes for the public on quality outcomes in the inpatient care setting and demonstrate measures for continuous quality improvement 3.To track and publish outcomes for access on the quality outcomes for outpatient and emergent services delivered in the new rural repurposed hospitals as well as a the tertiary care centers4.To track and publish the quality outcomes and demonstrate improvement in quality outcomes annually by tracking measures utilizing the EMR. The EMR should track all major healthcare services offered. To be complete the following should be committed to:a.Establish a common EMR to and outcomes tracking system to include:5.Improved prevention programs that decrease the need for inpatient services (over time). The workgroup believes at a minimum the application should include a commitment to improved access to preventive and health maintenance services in all areas where current acute care facilities exist to including (but not limited to):a.emergency trauma careb.stroke and cardiac disease prevention c.stroke and cardiac disease treatment and outcomesd.cancer prevention and treatment outcomes for communities servede.obesity and diabetes prevention and outcomes for treatment programsf.substance abuse prevention and treatment outcomesg.outcomes measures for wellness programs targeted for the community and region based upon the epidemiologic findings from the research and services described.6.The Quality Workgroup believes that as a healthcare workforce is difficult to recruit and maintain in Southwest Virginia, therefore NEWCO should commit to quality healthcare training programs and should maintain and report on the quality of those programs in Southwest Virginia to include (but not limited to):a.medical residencies for physiciansb.osteopathic and allopathic medical student clinical education programsc.physical therapy student clinical education programsd.pharmacy clinical education programse.physician assistants f.nursing student education programs and advanced nursing education programs. 7.The Access Workgroup believes NEWCO should commit to working with the community providers including individual providers, federally qualified health centers and rural health clinics, free clinics, community service boards and health departments. NEWCO is committed in the application to an “open system” that will support and enhance these community based practices through EMR and other means. The commitment to this “open system” should be a requirement, to work with other community providers, and to not limit facilities to employed providers.8.NEWCO has voiced one reason for the application is to transition the current rural hospital to a model that will be sustainable as care continues to transition to community based and outpatient care models. NEWCO should commit to successful models of care they have used (or are planning to use) to provide and enhance community based care and outpatient care.9.An agreement to research outcomes and to implement continuous quality improvement programs (and revision to services provided in Southwest Virginia) in order assure an increase in quality of health of the citizens of Southwest Virginia. This will help to assure the advantages and benefits of the merger outweigh the disadvantages as related to quality of care. ................
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