REGION 15-REGIONAL HEALTHCARE PARTNERSHIP

Wednesday, February 20, 2013

1:00 p.m.

El Paso First Health Plans, Inc.

1145 Westmoreland Drive

El Paso, Texas 79925

PRESENT

/

PRESENT

James N. Valenti, President & CEO, Region 15 Anchor
Cathy Gibson, CCO, Lead Waiver Representative-UMC
Michael Nuñez, Chief Financial Officer-UMC
Frances Hanson, Gjerset & Lorenz, LLP (On Conference)
Mary Ann Gallegos, City of El Paso Health Department
Jim Paul, Hospice of El Paso
Domingo Betancourt, Tender Home Health
Ana Rodriguez-McConnell, Tender Home Health
Angie Meraz, Tender Home Health
Cynthia D. Horton, VNA
David Palafox, El Paso County Medical Society
Bertha Gallardo, Las Palmas/Del Sol
Frank Dominguez, El Paso First
Rene Navarro, Centro San Vicente
Donald McTufts, Centro San Vicente / Cynthia Moreno, EHN
Chrystal Davis, EHN
Blas Meza, UMC
David Smead, UMC
Lorrie Giessel, UMC
Joe Garcia, UMC
Maria Zampini, UMC, VP Operations
Diana Fancher, DPN, UMC, CNO
Charles Handley, Sierra Providence Health Network
SUPPORT STAFF
Betsy Castillo, Executive Assistant, CEO
Maria Luisa Escobar, Recording Secretary
1. CALL TO ORDER & WELCOME

Mr. Valenti called the meeting to order at 1:10 p.m.

2. APPROVAL OF THE MINUTES FROM THE JANUARY 29, 2013 MEETING.

Mr. Valenti noted that the minutes were on the website at www.epchd.org and invited any comments from the audience. Hearing no comments the minutes for January 29, 2013 were adopted as presented.

3. CONFIRMATION OF PARTICIPANTS – ROLL CALL

Mr. Valenti invited the attendees to introduce themselves and the participating agencies to confirm everyone’s presence at today’s RHP meeting.

4. RECAP FROM ANCHOR CALL 2/15/2013

Ms. Gibson explained that they are on hold again as the Plan was submitted last Friday. They anticipate that by Monday, February 25, 2013 it will go on to CMS.

She provided some information on feedback received on four projects with very minimal corrections which have been made. CMS will have a 45 day review period communicating with the various regions.

5. HHSC/CMS REVIEW PERIOD FOR REGION 15

There have been some modifications requested by CMS to Category III on the achievement targets. Ms. Hansen (on conference) explained that they have not had any information on the modifications requested by CMS. What they were looking at in Category III, the focus was the choice of Category III and whether it was appropriate for the project. The intent is to approve all parts of the plan with the exception of Category III payment in DY 4 & DY 5.

CMS is also looking at the “Other” project category for evidence based language and they will be flagging the high value dollar projects as they move on to CMS. They looked at Tier IV whereas they will be flagging $5M. Ms. Hansen added that there will be a higher number for Region III which is in Houston and that might be up to $10M. She added that it is anticipated that for El Paso it would be about $6M-8M.

6. UC AND DSRIP PAYMENT TIMELINES

Ms. Gibson reviewed the DSRIP and UC DY1 Payment Timelines as they appear on the slide with the various IGT entities and the amounts they will be receiving. DY 1 DSRIP-Region 15 is anticipated to be $22M with an IGT due on the 22nd of March for a payment due date of April 30, 2013 for submitting the Plan. The DY 1 UC payment would come on May 7, 2013. She added that the amounts due to each of the IGT entities are listed and the IGT would be due 20 days prior.

Mr. Nuñez added that for the DY1 UC of 7/20/2013 would cover Q1 & Q2 of DY 2 and Q3 would be paid January 16, 2014 and Q4 would be March 28, 2014. Mr. Valenti added that there seems to be a misunderstanding with CMS on the number of quarters on the make-up of a fiscal year and the need to receive timely reimbursements to meet budgeted numbers.

Mr. Nuñez added that Q1 and Q2 payments will be based on DY1 UC Tool prepared in the October/November timeframe. The last two quarters in January and March will be based on the DY 2 UC Tool which will be coming out sometime after July.

There will be a ½% retained of all DSRIP payments for monitoring purposes as was announced at the latest anchor call.

7. REVIEW AND DISCUSS REGION 15 PROJECT(S) WITH THE RHP

Ms. Gibson noted that there is a CQI metric within the project requiring two meetings per month to discuss the various projects; a brief summary of what is anticipated to accomplish and the process milestones. Ms. Hanson explained that not all of the projects have CQI metrics but they do have the two meeting requirements.

Mr. Valenti explained that for the project they have stated that they would be meeting with the team both internally and at the regular monthly meetings to go over the status and updates of the various projects. These are CQI and reporting must be made with minutes provided on the meetings held. He added that for UMC they selected two meetings per month and to satisfy the matrix and awareness of the projects. Ms. Gibson noted that the only way to get credit for the individual projects would be to report on each of them. The guidelines state that this cannot take place only internally but must involve the RHP for ideas and feedback.

Ms. Diana Fancher-UMC CFO

Expanded Residency Program (138951211.1.1 & 138951211.3.1) - the goal is to expand residencies and fellowship for specialty care. In 1996 the government capped the funding for these projects and since El Paso is an underserved area with only 116 for 100,000 residents and the state average being 162 per 100K residents the growth of the medical and specialty care in this area is very vital towards having a full healthcare system. The CQI measure is to meet bi-weekly and the other measures are related to retention of subspecialists and residents in El Paso County. Surveys will be conducted on 100 residents per year starting in DY 3 to assess their desire to remain in the area and facilitate that.

Electronic Medical Record Implementation (138951211.1.2 & 138951211.3.2) -This is related to data assimilation and transmission to the related organizations that need the information. This is related to “Meaningful Use” which will help the hospital be compliance with the IT Strategic Plan for the government and CMS.

Nurse Residency Simulation Lab Component (138951211.1.6 & 138951211.3.6) -The IOM came out with a report related to the future of nursing in 2010 and one of the strong recommendations is for hospitals to establish a Nurse Residency Program and train nurses to stay in the profession, feel supported, and be confident in their field.

High Risk Surgery Patients (138951211.2.8 & 138951211.3.16) - A guidebook is being drafted and nurses are being trained to follow up on their discharge as a lot of the patients have complex needs and don’t have primary care providers. They will be working with the various clinics and resources to manage these patients in the outpatient setting so that they don’t return to the hospital within 30 days.

Psychiatric Nurse Liaison (138951211.1.8 & 138951211.3.8) - this is for the hospital’s inpatient population as currently there is a lot of focus on the psychiatric patients in the ER; however there are a lot of these patients in the inpatient setting that need to be followed and sometimes they are bumped out of line in placing them into a psychiatric facility and they are trying to manage these patients closely to get them into the community and assure that they are able to function.

Ms. Gibson noted that this is one of the projects that are currently in the “Other Category” and she inquired of Ms. Crystal Davis if they might be able to assist in the development of evidence based language in the project. Ms. Davis stated that they would be happy to provide Mr. Blas Meza with some literature.

Hospital Throughput (138951211.2.9 Pass 2 & 138951211.3.17 Pass 2) - the hospital is working with a team from LEAN on finding ways to improve ED throughput and streamline all the components related to patient care to ensure the provision of efficient continuum for the patients. This requires working closely with the medical staff to make sure that they are getting the patients through the system in a more cost efficient way and avoid 30 day readmissions.

Mr. David Smead-UMC

Salvation Army-Red Shield Health (138951211.2.1 & 138951211.3.9) - This is a holistic wellness program for the homeless and is designed to provide nursing care and wellness program to the indigent patients that reside at the Salvation Army. There are a lot visits from the Salvation Army via ambulance trips to the ED and they are trying to provide a wellness program done in conjunction with VNA who will provide the nursing care. There are some additional items such as a fitness person, additional support for more nutritious meals by providing kitchen equipment. There are 350 homeless families with children that reside there and there are about 1K unique individuals that require individual interventions.

Ms. Cynthia D. Horton, VNA Representative expressed her excitement with this program. She added that one of the interventions would be education to teach them how to take over their care. There will be classes, etc. (138951211.2.2 & 138951211.3.10)

Rescue Mission Project (138951211.2.2 & 138951211.3.10) - This is a similar project in cooperation with VNA where they see the same kind of them coming from the Rescue Mission. The only thing they will not be doing there is the nutritionist and the wellness person or the meals. They do have a cooperative effort with the VNA who will be providing the similar education. The aim with these individuals is that if they do need medical care is to get them into the various clinics to work with the DSRIP projects and the clinics across the county rather than the ED.

Discharge Facilitation/Navigation for High Risk Patients (138951211.2.3 & 138951211.3.11) -The hospital is working closely with “Care Transitions” at the University of Colorado and a Care Transitions Coordinator has been hired and a few of these people will be attending the University of Colorado for the specialized training. They will be going towards a different role from a helper and teach them to be a coach. Patients will be assessed prior to discharge and their needs will be documented and what they will need at their home, followed by phone calls in order to reduce the 30 day readmissions rate.

Hospice Care for Uncompensated Patients (138951211.2.7 & 138951211.3.15) - The hospital has partnered with Hospice of El Paso for this program and Mr. Jim Paul and his team were just at UMC providing training for the case managers and social workers on the program. They will be training on how to transition the indigents from the hospital setting to hospice care and training will also be provided to the physicians so that they understand what the care is about. Mr. Jim Paul stated that the staff was very interested in the program and a lot of questions were voiced. He added that the biggest problem faced by the case workers and social workers is getting the doctors to tell the families and patients that they are going to die. There was a lot of interest in the symposium that Dr. Getta will be providing to the physicians. Mr. Smead noted that one of the metrics of this program is the training of the physicians and social workers and as they develop the programs and get them on board with Hospice of El Paso, they will be meeting the metrics that are required to be compliant with the project.

Ms. Sarah Allen-UMC Clinics Director

Expansion of existing clinical spaces-opened west side clinic on Crossroads (138951211.1.3 & 138951211.3.3) and Mesa and they will be expanding hours of operation three days a week for primary care. Expansion and grand opening of the Eastside Clinic (138951211.1.4 & 138951211.3.4) took place on January 17, 2013 that aside from primary services will be providing ancillary, lab and soon to come pharmacy. The clinic is opened two nights a week and plans are to open every evening by the end of summer. The Ysleta and Fabens clinics (138951211.1.5 & 138951211.3.5) have expanded their hours with another family practice physician added to the Fabens Clinic. The Internal Medicine Physician is backed up and it is about 60 days to get an appointment and a second physician was recruited as well as a mid-level provider to assist in the evening hours.

Increase Quality (138951211.1.7 & 138951211.3.7) - Quality Assurance Nurse is being sought as well as a meaningful use nurse to have 30 providers by the end of summer.

Medical Home Status (138951211.2.4 & 138951211.3.12) - Medical Care Act is focusing on this initiative and the hospital is working to achieve these metrics by updating the medical records functionality, registry system to reach this certification.

Coumadin Clinic (138951211.2.6 & 138951211.3.14) - there are about 6-12 patients weekly discharged from the hospital on Coumadin for cardiovascular or stroke related problems but these patients have a lot of morbidity issues that got them into the hospital. UMC has seen about 100 patients in the past few months and they are seen at recurring times.

Chronic Care Model (138951211.2.5 & 138951211.3.13) - look at the total care in a provider based clinic setting. It is a way of looking at good provider systems and provider roles.

A member of the audience shared that their staff would be meeting with Mr. Smead and his staff tomorrow to provide a presentation on how to help with the Waiver project and be an extension of the health system. It takes more than one home visit to get the patients to engage. They are using motivational interviewing, etc. to get the patients involved.