FY2018 BUDGET GREEN MOUNTAIN CARE BOARD AUGUST 17, 2017 Grace Cottage Hospital
Introductions Roger Allbee, CEO Stephen Brown, CFO Dr. Christopher Schmidt, CMO Crystal Mansfield, Director Rehabilitation CHT & Wellness Andrea Seaton, Executive Director of Grace Cottage Foundation
Rutland Reg. Med Center Mt. Ascutney Hospital Springfield Hospital Southwestern VT Brattleboro Memorial Hospital Medical Center
Location, Location, Location… Grace Cottage Hospital Orange = Primary Service Area Yellow = Secondary Service Area
Hospital Family Health Primary Care Inpatient Acute Care Inpatient Rehabilitation/Swing Bed Family Medicine Inpatient End-of-Life Care Pediatrics Emergency Department Mental Health Infusion Therapy Community Health Team Diagnostic Imaging RN Care/Outreach Coordinators Laboratory Behavioral Health Specialist Outpatient Rehabilitation Occupational Therapy Diabetes Educator Physical Therapy Health Coach Speech Therapy Resource Advocate Chiropractic Dental Health Resource
Payer Mix FY 2018 Clinic Hosp 0% 10% 20% 30% 40% 50% 60% 70% Medicare Medicaid Self Commercial
Medicaid Subsidy FY 2016 Gross Medicaid Charges (per FY16 Actuals) $4,375,514 Cost to provide those services (75.33%) $3,296,223 Actual Medicaid reimbursement (36.7% of charges, 48.8% of cost) $1,607,051 Shortfall of reimbursement vs actual cost to provide services $1,689,172 Medicaid Provider Tax paid $621,491 Disproportionate Share Payments received* $0 Net Grace Cottage subsidy to State of Vermont - FY2016 $2,310,663 * Grace Cottage is not eligible for DSH payments due to the federal obstetrical requirement
Working to Serve the Community - ED Safe Room The Emergency Department safe room allows the hospital to more safely and effectively treat patients with acute behavioral health concerns. It was deemed an essential component of our ED, twelve supporters in the community donated the $22,000 needed for the project. When not used for psychiatric patients it is used as an additional ED exam room.
WHERE OUR ED TRANSFERS GO 90 80 70 60 50 40 30 2017 20 10 2016 0 2017 Year to date 2016
WHERE SWING BED PATIENTS COME FROM 80 70 60 50 40 30 20 10 0 BMH DHMC GCH Springfield Cheshire VA: White Bennington Other River Jct 2016 2017 Year to date
Inpatient Rehab Visits 1200 1000 800 600 400 200 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2016 2017 Year to date
Outpatient Rehab Visits Outpatient Rehab FY 2016 Outpatient Rehab FY 2017 700 600 600 500 500 400 400 300 300 200 200 100 100 0 0 Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept ST ST 0 0 2 2 9 9 2 4 1 4 13 10 6 1 0 0 0 4 4 2 7 5 OT 30 40 34 47 33 63 39 22 22 8 17 15 OT 11 18 19 21 28 36 27 39 33 19 PT 483 473 472 500 479 519 509 521 543 487 528 489 PT 432 378 458 396 365 495 473 506 511 520 PT OT ST PT OT ST
Primary Care Practice Sites Grace Cottage Family Health
Family Health Providers
Family Health Growth New Patients FY 2017 New Patients FY 2016 (OCT - DEC) (OCT - DEC) (JAN -MAR) (JAN - MAR) (APR - JUN) (APR - JUN) (JUL - SEP) (JUL - SEP) 0 20 40 60 80 100 120 140 160 0 20 40 60 80 100 120 140 160 180 Behavioral Health Primary Care Behavioral Health Primary Care
Behavioral Health Encounters FY 2016 FY 2017 180 180 160 160 140 140 120 120 100 100 80 80 60 60 40 40 20 20 0 0 PNP PNP LICSW
Primary Care Referrals to Specialty Services Referrals 10-2016 to 8-2017 1% Alice Peck Day 22% BMH 1% Cheshire Medical Center 2% Dartmouth 51% Rutland 13% SVMC Other 10%
Aging Cancer – Colon High Priority Cancer – Breast Diabetes Heart Disease/ High Blood Pressure Mental Health Alcoholism & Substance Abuse Cultural Competency Medium Priority Difficulty Navigating the System Financial Barriers Flu vaccinations Obesity/Overweight/Physical Fitness Smoking/Tobacco Use Chronic Pain Dental Low Priority Transportation
CHT FTE Original FTE Added FTE Original CHT served Expanded CHT 246 now serves patient 0.40 on average visits in 900 patient the first visits per 1.00 0.60 0.80 1.00 quarter quarter 0.60 0.20 0.10 GC RN CARE GC HEALTH GC GH DIABETES GC OUTREACH COORDINATOR COACH BEHAVIORAL EDUCATOR COORDINATOR HEALTH SPECIALIST
CHT Patient Encounters 400 350 300 250 200 150 100 50 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2016 2017
Success stories of the CHT: Home visit to check on BP and diabetes medication compliance; patient found to be living in complete squalor in trailer filled with mold and rot. (Patient’s grandaughter, son, daughter-in-law also live there in “back shed”…. grandaughter admitted to DHMC with issues from exposure to mold). The CHT contacted SEVCA, and in collaboration with this agency completed all forms and necessary paperwork to obtain funding for a brand new replacement trailer for this family. Patient was most recently visited by CHT and notes increased compliance with medication regimes, is feeling “like somebody cares about us” and has now referred her family members to Grace Cottage for their medical care. 65 year-old man with severe back pain, heart issues, diabetic – Changed his diet to remove refined carbs, overabundance of saturated fat (addicted to ice cream), learned to chew his food well, drink plenty of water, eat a Paleo plant based diet – lost 30 pounds, can now walk 2 miles a day without lower back pain, reduced his blood pressure meds dose.
Success stories of the CHT: 78 year-old female, changed her diet to reduce starch and sugars, drink more water, walk more, eat 4 cups a day of fruits and vegetables, is no longer pre-diabetic. 65 year-old male living in assisted living – put on a limit of 130 carbs a day, plant based diet, protein with each meal and snack, plenty of water, chewing well. Has lost 100 pounds and in another 50 pounds will be eligible for knee surgery. 38 year-old obese female. Has lost 30 pounds, no longer at risk for diabetes, all lab values healthy. 40 year-old male, diabetic on metformin. Changed his diet to plants, clean proteins, chewing well and plenty of clean water. A1c reduced to no longer needing metformin.
Healthcare Matters Grace Cottage Hospital’s Healthcare Matters premieres on BCTV. Marty Cohn hosts episode two, Back to School, with guests Melinda Roy, Pediatric Occupational Therapist, and Liz Harrison, Community Health Team Health Coach.
Aging Population of Grace Cottage Community Service Area Grace Cottage Hospital is indicated with the blue marker. Most of the surrounding area shows an aging population. The darkest orange indicates that over 20% of the population is aged 65 or older. Most of Grace Cottage Hospital’s primary service area is shaded in the darkest orange. Source: U.S. Census Bureau, Census Explorer, 65 and Over, at http://www.census.gov/censusexplorer/cen susexplorer.html
Healthy Aging Conference TAKE CHARGE of your own health, your security, and perhaps even your longevity at the Healthy Aging Conference on November 7-8, 2017 at the historic Grafton Inn in Grafton, VT.
Healthy Valley 2040 Overview and Update: The ultimate goal of Healthy Valley 2040 is to lay the foundation for a long- term collaborative campaign aimed at advancing population health in the West River Valley region. A three-phase project. This collective impact project will take years to complete, thus the name “Healthy Valley 2040.” The goal of Phase 1 — the phase funded by the Windham Foundation — was to bring together a broad spectrum of community members to assess the existing resources within the West River Valley, and to discuss current challenges and gaps in services.
Healthy Valley 2040 Three collaborative meetings were held, led by a professional facilitator, with the aim of creating a shared vision statement, initial goals, and a steering group to carry to work forward into Phase 2. A total of 40 participants, representing 24 different organizations attended sessions held in February, March, and May of 2017. Phase 1 is complete. The steering committee is currently meeting to organize “next steps” to include: a multi - agency community “Walk a Mile a Day Challenge” to launch in the fall; a “Drink up H2O” campaign to launch in the spring; a high school logo contest for the branding of HV2040; and a multi- generational calendar focusing on healthy living in the valley to launch next autumn.
Grace Cottage Foundation Individual Donations 2013 1723 2014 2040 2015 2060 2016 1984 2017 2292 0 500 1000 1500 2000 2500
Grace Cottage Foundation Amount Raised 2013 $815,700 2014 $903,400 2015 $1,318,000 2016 $1,102,636 2017 $1,232,078 $0 $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000
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