Critical Access Hospital Status and the Continuum of Care

1
Critical Access Hospital Status and the
Continuum of Care
Presented by Kathy Kaplan, RN-C Mark Brown, MD
2
(No Transcript)
3
Located next to Acadia National Park
4
A Stones Throw From the Ocean
5
About MDI Hospital

• Established in 1897
• Service area includes Mount Desert Island, the
  Cranberry Islands, Swans Island, Lamoine and
  Trenton
• Year-round population approximately 12,000
• Seasonal population fluctuation 40,000
• 3 million visitors per year

6
About MDI Hospital

• Employs approximately 300
• 24-hour ER
• 15 Acute beds
• 10 Swing Beds
• 8 Outpatient Health Centers, including Behavioral
  Health Center

7
About MDI Hospital

• ER visits - 7,667 (FY 03)
• Discharges - 1,317 (FY 03)
• Total Outpatient/Inpatient Payor Mix
• 55 Medicare
• 5 Medicaid
• 4 Self-Pay
• 35 3rd Party Payor

8
About MDI Hospital

• 7 Family Practitioners
• 4 Internists
• 2 Hospitalists
• 1 Psychiatrist
• 1 Oncologist (from EMMC)

9
About MDI Hospital

• 2 General Surgeons
• 1 Orthopedic Surgeon
• 3 Ophthalmologists
• 2 Radiologist
• 1 Urologist
• Mid-level practitioners

10
Community Health Resources Within 25 Mile Radius

• 3 Medicare Certified Skilled Nursing Facilities
• 1 40 bed Residential Care Facility
• 1 Retirement Community w/16 Alzheimers 16
  independent living apts.
• 1 Boarding Home off Island
• 2 Medicare Certified Home Health
• 1 Private Home Health Agency
• Volunteer Hospice

11
MDIH Prior to CAH Status

• Average Length Of Stay - 3.83 days (Avg. of 1998
  1999)
• Average Census -18
• Re-admit Rate - 6.5

12
What Is Critical Access Hospital Status?

• A federal designation established by Balanced
  Budget Act in 1997
• Nationally - 750 CAH Hospitals (as of 6/03)
• Maine - Eight CAH Hospitals

13
What Is Critical Access Hospital Status?

• Limits average length-of-stay (4 days) and
  average daily census (25 total beds w/15 acute)
• Provides Cost-based reimbursement

14
CAH at MDIH - Timeline

• 1999 Hospital administration and medical staff
  discuss Critical Access Status impact/opportunitie
  s

15
CAH at MDIH - Timeline

• 1999 - Medical staff expresses concerns

- No longer a real, full service hospital -
Band-Aid Station - Limit our ability to care
for critically-ill patients - Surgeons
concerned some cases would be limited - Loss of
professional satisfaction
16
CAH at MDIH - Timeline

• 1999 - Hospital conducts its own in-house CAH
  feasibility study
• 1999 - Rural Hospital Flexibility Program Grant
  funding used to hire a consultant to conduct CAH
  feasibility study
• 2000 - Studies reveal a good match for MDIH and
  Critical Access Status

17
CAH at MDIH - Timeline

• October 2000 MDI Hospital applies for and
  receives Critical Access Status designation
• October 2000 Certificate of Need approved.
  Swing Bed Program begins.

18
Swing Bed Care Management at MDIH
Interdisciplinary Team Includes

• Pharmacy
• Physical Therapy
• Occupational Therapy
• Nursing
• Activities Director
• Social Service

• UR/Discharge Planning
• Hospitalist
• Nutrition
• Respiratory Therapy
• 3 Nurse Care Managers
• Behavioral Health

19
Swing Bed Care Management at MDIH

• Care Managers works directly with patients,
  providers, family members to coordinate care

20

• Utilization Comparison - Before and After Care
• Management Involvement

21
Highest Utilizers

• Married and or Widowed
• Female
• 70
• Income Level 10,000 or Under
• On Medicare

22
Critical Access Hospital Status - 3 Years Later
Average length of stay for acute patients
reduced by over one day (3.83 days before CAH to
2.79 days after) Average length of stay for
Swing Bed patients 5.6 days Fewer re-admissions
to the hospital
23
Critical Access Hospital Status - 3 Years Later

• Swing Bed program provides more choices and
  physician access to patients
• Hospitalist program helps us function as a
  Critical Access Hospital
• Care management has helped us improve
  quality/continuity of care

24
Critical Access Hospital Status - 3 Years Later

• Increased paperwork for physicians
• Physicians need to be aware of LOS and limited
  beds
• Physicians more aware of discharge planning at
  point of admission
• Physicians working more efficiently within the
  system

25
Critical Access Hospital Status - 3 Years Later

• Finished FY 03 w/operating gain for first time
  in 5 years
• Increased medical staff
• Improved services (MRI/CT scanner)
• National awards for patient satisfaction (1
  overall patient satisfaction award 4 ASU
  awards)

26
Critical Access Hospital Status - 3 Years Later
Reasons For Our Success

• Experienced, skilled employees
• Good Communication
• Administration/Medical Staff Support
• Nursing Staff Buy-In
• Hospitalist Program