antelope valley hospital - HFMA Southern California and San Diego

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CFO Panel
Sue Anderson- Central Coast Region, Dignity Health
Ed Salvador, St Jude Medical Center
Cheryl Tong, Antelope Valley Hospital and Healthcare District
Moderator
Steve Blake, IHHI
HFMA Presentation
September 2012
Sue Andersen
Dignity Health Central Coast Service Area
Northern Santa Barbara and San Luis Obispo Service Areas
Santa Maria Area:
Cambria
Santa Maria / Orcutt
Cuyama / New Cuyama
Guadalupe
Los Alamos
Sisquoc
Nipomo
Atascadero
Cayucos
Morro Bay
San Luis Obispo
Los Osos
Pismo
Arro
Arro
Arro
Gra
Gra
Ho
Ho
iiita
ta
Arro
Arro
Arroy
yy
y
yo
oo
o
oGra
Gra
Gra
Gran
nn
n
nd
dd
d
de
ee
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eHo
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Hos
ss
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sp
pp
p
piii iiita
ta
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talll lll lll
Arro
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y
yy
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o
oo
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Gra
Gra
Gra
n
nn
n
d
dd
d
e
ee
e
Ho
Ho
Ho
s
ss
s
p
pp
p
ta
ta
ta
Arroyo Grande
New Cuyama
Nipomo
Santa Maria
Cuyama
Arroyo Grande Area:
M
M
Ma
aa
aa
ari
riri
riri
ria
aa
aa
an
nn
nn
nM
M
M
Me
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dd
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ca
aa
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allll llCe
Ce
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Cen
nnn
nte
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terrrrrr
M
M
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Ce
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M
aa
ari
riri
aa
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Guadalupe
Orcutt
HW
Y
Los Alamos
1
10
Arroyo Grande
Grover Beach / Oceano
Pismo Beach
Shell Beach
Avila Beach
LL
LL
Lo
oo
oo
om
m
m
mp
pp
pp
po
oo
oo
oc
cc
cc
cDi
Di
Di
Dis
ss
ss
stri
tri
tri
tric
cc
cc
ctttttttttHo
Ho
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Hos
ss
ss
sp
pp
pp
piii iiita
ta
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talll lll lll
L
L
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m
m
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p
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L
m
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tri
tri
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San Luis Obispo Area:
Lompoc
Avila Beach
Los Osos
San Luis Obispo
Morro Bay / Cayucos
Cambria
Santa Margarita
Paso Robles
Atascadero / Templeton
3
Our Lady of Perpetual Help Hospital
Where we started…
On May 20, 1940,
Our Lady of Perpetual
Help Hospital opened
its doors and heart to
the 8,000 residents of
Santa Maria.
4
Marian Hospital
1960’s: The Population Booms
By 1967, Santa Maria’s population had tripled
to nearly 25,000.
The community and hospital joined
forces and through a generous land
grant from Captain and Mrs. Allan
Hancock, a new hospital was born…
Marian Hospital.
5
Marian Regional Medical Center – New Building Opened May 22, 2012
Mission Hope Cancer Center
7
Arroyo Grande Community Hospital
 Arroyo Grande
Community Hospital has
grown through five
construction expansions:
– 1975, AMI expanded the hospital to 79 beds and added an ICU, expanded ER services and
medical surgical beds
– 1977, the ER and surgical suites were expanded and pharmacy and nuclear medicine rooms
were added
– In the late 1980s, the existing two lobbies were constructed and a new ER was added
– 1992, $9.0M expansion to renovate the hospital
– 2004 – Joined Catholic Healthcare West
– 2011, CHW added the Acute Rehab service to the hospital’s delivery capabilities
8
Acute Rehab Center
Opened Acute Rehab Center in July of 2011
9
French Hospital Medical Center
• Designated Top 100 Hospital by Thomson-Reuters
• Top 50 Cardiac Hospitals
• Founded by Dr Edison French. Owned by several for profits until 2004 when it was
bought by CHW and SLOPHA.
• $22M Improvement Plan in Process
Service Area Map
San Miguel
• Map / maps to provide geographic perspective
S
Templeton
for team S
S
Home Care
Draw Station
Morro Bay
Draw Station
Los Osos
ASC JV
FRENCH HOSPITAL
MEDICAL CENTER
San Luis Obispo
French Clinic
8
5
Home Care
Imaging Center
ASC
Arroyo Grande
We have central coast entitySmap from board retreat
Home Care
ARROYO GRANDE
COMMUNITY HOSPITAL
Combined
Population Data By Age
0-14
PACIFIC OCEAN
82,763
190,640
45-64
110,410
65+
63,102
TOTAL
S
Clinic
15-44
Clinic
446,916
S
MARIAN
MEDICAL CENTER
MARIAN WEST
Marian Extended Care
ASC Partnership
Imaging Center
Home Care
LEGEND
= Surgery Center
S = Draw Station
11
= Competitor Hospital
Santa Maria
S Coastal Valley Internal Medicine
Lompoc
= Clinic and Home Health
= Diagnostic Imaging Center
11
M
I
L
E
S
Service Area - Overview
Market Environment
Performance
• FY 12 EBIDA Margin: 7.12%
• Service Line Margin leaders:
CV, General Surgery, OP
Imaging & Lab, GI ,
Neurology, Oncology,
Perinatalogy
• Positive performance on MCR
cost Index
• Top 100 Hospital Ranking for
French
• 55% market share; Tenet 31%, Other 14%
(outmigration)
• Each campus has an affiliated ASC
• OP Imaging at two campuses
• Competing OP imaging and labs
• Growth projected in Santa Maria Valley and
Northern SLO County
• Have branded OP oncology at all campuses,
e.g., Mission Hope Cancer Center
• Leader in CV, Gen Medicine, Oncology,
Obstetrics & Orthopedics
• Areas of Opportunity – Neurosurgery and
NICU
• Homecare / Hospice / Infusion Services
• Primary Care Clinics
Payor Landscape
• BC/BS cover 75% of commercial
lives
• Low ratio of HMO to PPO
penetration (1:2)
• Heritage/Regal IPA significant
presence – CCPN
• CCPN forming ACO
• GEMCare providing senior
product and starting commercial
plan with Physician Choice IPA
• Managed Medi-Cal – CenCal
12
Service Area – Overview – cont.
Physician Landscape
• Most MDs are independent or in
small single specialty groups
• Two IPAs in service area - CCPN
(360 MDs) and Physician’s Choice
(360 MDs)
• Dominate groups in several
specialties, e.g., general surgery,
CV, cardiology, oncology
Consumer/ Employer
• San Luis Obispo and Santa Maria
historically separate communities.
• Ethnically diverse, lower
income, and younger
population in growth areas (Santa Maria
city and N SLO)
• Unemployment and uninsured slightly
higher than benchmarks
• Aging population with 65+ growth rate of
3.9% versus total market of 1.3%
• Economy driven predominantly by small
business (70%)
• Agribusiness, government , education and
small business
Community Need
• Physician shortages across
majority of specialties – 20+
FP/IM needs in service area
• Community clinics
addressing areas of most
underserved
• Provided $26.9 M in
community benefit in FY11
13
Central Coast Service Area
Three Hospitals:
•Marian
•French
•Arroyo Grande
NICU
Acute Rehab
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Mission Hope Cancer Ctr
• 2Breast Imaging Centers
Clinics (6):
•Rural Hlth
•Subgrantee FQHC
•Community Hlth Ctrs
Three Surgery Ctrs
•Joint Ventures
OP Lab and X-Ray
Cancer Services
Patients,
Families &
Community
EPO Health Plan
3 Foundations
Extended Care Center
•Sub-Acute
•SNF
Children’s Center
Hospital Homecare/
Hospice/Infusion Services
•Santa Maria
•Lompoc
•Arroyo Grande
•Templeton
•San Luis Obispo
Physical & Occupational
Rehab Services
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Health & Wellness Center
•Cardiac Rehab
•Pulmonary Rehab
•Wellness
Thank You
St. Jude Medical Center
St. Jude Medical Center
2720 North Harbor Blvd., Fullerton, CA 92835
www.stjudemedicalcenter.org
FY11 Key Indicators
Licensed Beds
384
Physicians on Staff
742
Employees
2,330
Average Daily Census
225.0
Average Length of Stay
5.0
Inpatient Discharges
16,272
Outpatient Visits
431,073
Total ED Visits
60,443
ED Visits without Admit
49,262
Admissions from ED
11,181
Key Services:
• Audiology
• Cardiac
• Community Outreach
• Emergency
• Gastroenterology
• Home Health
• Hospice Care
• Imaging
• Maternity & NICU
• Minimally Invasive Surgery
• Neurosurgery
• Orthopedic
• Palliative Care
• Pathology
• Pulmonary
• Radiology & Imaging
• Robotic Surgery
• Senior
• Speech Therapy
• Stroke
• Surgery
• Vascular
• Women’s & Children’s
• Wound Care
Centers/Institutes:
• Brain Injury Center
• Breast Center
• Cancer Center
• Caregiver Resource Center
• Centers for Rehabilitation
& Wellness
• Chronic Pain Center
• Endoscopy Center
• Sleep Disorders Institute
• Spinal Cord Injury Center
• Synergy Medical Fitness
Center
• Transitional Care Center
Primary Service Area:
La Habra, Fullerton, Brea, Placentia, Yorba Linda, La
Mirada, Diamond Bar, Rowland Heights, Buena Park,
Chino Hills
Primary Service Area
Secondary Service
Area
Secondary Service Area:
Anaheim, Walnut, Whittier, Corona,
Hacienda Heights, Chino
17
17
Sources: SJHS Finance, OSHPD ALIRTS, ESRI, Intellimed 2011
The Evolving Marketplace
THEN
NOW
 Monarch Healthcare
 United Healthcare
 Bristol Park Medical Group
 Memorial Care
 Greater Newport Physicians
 Memorial Care
 Caremore
 Blue Cross
 Kaiser Permanente
 OC Expansion
 Healthcare Partners
 Bright Medical Physician
Medical Group
 St. Jude Heritage Medical Group
 Rumored Discussions
 Presbyterian Intercommunity
Hospital
 St. Jude Medical Center
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WellPoint to buy
CareMore Health
Group for about
$800 million
The deal is part of an effort
by WellPoint to boost its
presence in the senior care
market. CareMore, based in
Cerritos, has 26 clinics in
California, Nevada and
Arizona that specialize in
caring for people on
Medicare.
June 09, 2011|By Shan Li, Los
Angeles Times
BREAKING NEWS FROM MEMORIALCARE HEALTH
SYSTEM: Four Physician Groups Join New MemorialCare
foundation:December 16, 2010
Blue Shield of California, Greater
Newport Physicians Medical Group
and Hoag Memorial Hospital
Presbyterian to Collaborate on
Coordinated Care Model to Improve
Quality and Reduce Healthcare Costs
PR Newswire
SAN FRANCISCO and NEWPORT BEACH, Calif., Feb. 27,
2012
Greater Newport announces affiliation with
MemorialCare foundation
By Andis Robeznieks Posted: February 28, 2012 - 6:45 pm ET
Kaiser opens new building in Anaheim
September 25th, 2009, 6:00 am by Courtney Perkes
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Mergers & Acquisitions
We are Transforming to Meet our Mission
Current Systems of CARE
As we transform to a system of care, the importance of tight connections across the continuum of
care grows.
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ANTELOPE VALLEY HOSPITAL
A facility of Antelope Valley Healthcare District
HFMA Fall Conference – September 2012
Presented by: Cheryl Tong
ANTELOPE VALLEY HEALTHCARE DISTRICT
 Antelope Valley Healthcare District is a political subdivision of the
State of California and was organized on January 20, 1953 (under the
provisions of the Health and Safety Code of the State of California governing Local
Health Care Districts)
♦ Located in Lancaster, CA in northern Los Angeles County in the high
desert, near the Kern County line. Lancaster currently ranks as the
30th largest city in California
♦ Governed by a five-member Board of Directors, elected by voters
within the District
♦ Antelope Valley Hospital is a “Non Designated” Public Hospital –
owned and operated by the District
♦ No Tax Levy
ANTELOPE VALLEY HOSPITAL - PAST
Antelope Valley Hospital commenced operations on October 12, 1955 with a
complement of 86 beds that gave access to quality health care for the then
12,000 residents of the Antelope Valley
ANTELOPE VALLEY HOSPITAL - PRESENT
Antelope Valley Hospital has expanded to 420 licensed beds as of 2006 and
serves a population of approximately 1.2 million people
SERVICES AND PARTNERSHIPS
ANTELOPE VALLEY MARKET
COMMUNITY
PHYSICIANS
1.2 million population
encompassing N. LA
County/S. Kern County
500 Medical Staff
Members
Average household
income below $50k
Partnership with Kaiser
to provide ER &
inpatient services
Unemployment rate of
16%
Median Age is 32
37% Medi-Cal/
Uninsured
Majority of Medicare
pts. are Medi-Medi
Majority Independent
HOSPITAL
420 Licensed Beds
Stand Alone Acute Care
Hospital
Safety Net Hospital
Dominant Provider
One IPA in service area
4th busiest ER in the
State
Most do not accept
Medi-Cal
Level II Trauma Center
Only one County clinic in
the area
450+ Volunteers
2500+ Employees
ANTELOPE VALLEY HOSPITAL AND HEALTH SERVICES
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Hospital-Based Services - Main
Cardiac Cath Lab/STEMI-Receiving Center
da Vinci® Si Robotic Surgical System
Emergency Medicine and Level II Trauma
ICU/CCU
Inpatient Psychiatry
Pediatrics
Oncology
Endocrinology
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Gastroenterology
Inpatient/Outpatient Surgery
Neurology
Orthopedics
Plastic Surgery
Radiology/Imaging Service
Forensic Services Unit/SART
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Hospital-Based Services – Women Infant
Obstetrics (incl. surgical services)
Neonatal Intensive Care Unit
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Outpatient/Clinic-Based Services
Comprehensive Wound Healing Center
Home Health
Outpatient Surgery Center
Outpatient Reference Lab
Blood Donor Center
Obstetrics Clinic
Women’s, Infant, Children Pavilion –
provides nutritional care
Joint Ventures
(2) Outpatient Imaging Centers –
Lancaster & Palmdale
Desert Hill Sleep Disorder Center
ANTELOPE VALLEY HOSPITAL
STATISTICS
Patients Served:
 Average daily census – 285
 Inpatient discharges – greater than 25,000/year
 Surgeries (incl. OP Surg. Ctr.) – over 15,000 annually
 Babies delivered – approx. 5,500/year
• Emergency room visits - Over 110,000 annually (300/day)
o 15% inpatient admission rate
o 4th busiest ER in the State and 2nd busiest in L.A. County
• Level II Trauma Center - Average 75 patients/month
• EMS Base Station - Average 80 calls/day
ACADEMIC AFFILIATIONS AND PROGRAMS
 UCLA Emergency Medicine residency
 Robotic Surgery program with USC Institute of Urology
 Plastic Surgery/ENT residency program with USC
University Hospital
 Pediatric Intensive Care Unit with Loma Linda University
Medical Center
 American College of Osteopathic Medicine residency
rotation
MASTER FACILITY PLAN OVERVIEW
PHASE I
IN-PROGRESS OR RECENTLY COMPLETED
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Cardiovascular & Neurological Center of Excellence – Opens October
Parking Lot Improvements - September
Main Entrance Canopy - In Progress
Lobby Remodel - In Progress
Radiology Centralization - In Progress
Central Plant Upgrade: In-Progress
SB 1953 – Earthquake Retrofitting: In-Progress
Clinical Lab Relocation - Complete
Blood Donor Center Relocation - Complete
Café Remodel - Complete
Urology Department: Complete
Comprehensive Wound Care Center: Complete
Public Restroom/Elevator Lobby Upgrades- Complete
Surgeon’s Waiting Room Remodel: Complete
Surgery Waiting Room Remodel: Complete
Main Physicians Dictation/Lounge Remodel: Complete
FUTURE CANCER CENTER
PHASE II
NEW TOWER
Chosen Site will:
− East of the existing
patient tower
− Achieve connectivity to
both
existing tower and D&T
building
− Improve visibility from
Avenue J
− Allow continued service
without a decrease in
bed count
INFORMATION TECHNOLOGY
IT PROJECTS TO ACHIEVE “MEANINGFUL USE”
IN-PROGRESS OR RECENTLY COMPLETED
New System Implementations
• FairWarning (Security Monitoring)
• HED (Expert Doc: Interdisciplinary Doc) - Polaris II • Edge Switches - Upgrade for Add'l Workstations
• HARX (AdminRx: Barcode Med Admin)
• IT Security Risk Assessments
• HCR (Care Record: Data Repository) - Polaris II
• Blackberry/NEC Integration
• HHS (Heath Summary: Meds, Allergies, Problem
• Wireless Assessment/Upgrades
Lists) - Polaris II
• SAN Cisco Switch
• CAF (Common Application Framework: Patient
• End User Provisioning
Banner) - Polaris II
• Polaris Phase II Equipment Deployments
• HCA (Care Alerts) - Polaris II
• Replace Concentry
• HSM Perioperative Charting *Polaris Phase II*
• Remove Tandem
• HEP (Horizon Expert Plan: Care Plans)
• Bring Patient Statements In-House
• MobileCare Phlebotomy
• AVOIC MPI Centralization
• HEV (Horizon Enterprise Visibility)
• Horizon Tray & Instrument Manager
• Pharmacy Clinical Information Resource
• OSC & AVH Telephone Integration
• HPP Medication Reconciliation Module
• Exchange Upgrade
• Patient Self Check-In (ED)
• FTP Consolidation
• Quantros Implementation
• LINC Data Extraction
• PICIS Phase II
• VolWorks Replacement
• Med Staff Document Imaging System
• HHC Wound Module
• Zynx-Like Product (CPOE Order Sets)
• VMWare Farm Replacement
• Remedy Log On Form
• Amalga Phase II
• Canon Uniflow Implementation
• PeopleSoft (HR/Time Keeping/Payroll)
Upgrades to Existing Systems
• Adventura or Sentillian Roaming Desktop
• PACS Upgrade v11.1
• Meaningful Use Implementations
• HBB Upgrade v3.5
• Axiom Implementation
• SafeTrace Upgrade 4.0.4
• Bio Med Inventory Management
• PowerPath v 9.5 Upgrade
• Single Sign On
• HPF v15.1 Upgrade
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Centricity Perinatal Upgrade or Replacement
GE Muse EKG v5.00 E12 Upgrade
Risk Monitor Pro v4.22 Upgrade
Horizon Lab v15 Upgrade
TeleTracking Upgrade vXT
ImageCast (RIS) Upgrade v10.7
Remedy Upgrade (Base Product)
Amalga Upgrade to V2 R2 SP2
HDM v5 Upgrade
PCA v15 Upgrade
PCON v15 Upgrade
STAR ICD-10 Enablement
HCI v10.3 Upgrade
Dell Servers - Replacements
File Server - Permissions
Windows 7/Office 2010
Telephone Switch Upgrade (Wireless and Wired)
SV8500
Upgrade Unified VM Messaging UM8700
Upgrade MCS/DID (PBX Console)
Active Directory - Upgrade/Cleanup
iTMS Upgrade to 2010.4.2.11
Nurse Call & Vocera System
Upgrade E911 & Integrated Call Accounting
Upgrade Global Navigator
SAN DS8700 Upgrade
UPS Power Pack Replacements
SharePoint 2010 Upgrade
THE FUTURE OF HEALTHCARE
CHALLENGES AHEAD……….
● Medi-Cal reimbursement moving to CPEs (Certified Public Expenditures) for
District Hospitals similar to “Designated” Public Hospitals
• Elimination of 1255 DSH
• Delivery System Reform Incentive Payments – the goal of the DSRIP is to
“support California’s designated public hospitals efforts in meaningfully
enhancing the quality of care and the health of the patients and families they
serve”.
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Cuts to Medicare and Medicare DSH payments
Union Contract negotiations (CNA & SEIU)
Aging Facility – meet seismic retrofit standards
Meaningful Use
Dual eligible
ICD-10
ACO’s
THANK YOU
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Accountable Care Organizations
CMMI bundled payment pilot
Value Based Payments
Meaningful Use Requirements
Physician Alignment Models
Case Management Strategies
Cost Control
California Health Benefit Exchange
Dual Eligible
Medi-Cal APDRG
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CMMI bundled payment pilot:
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Retrospective Acute Care Hospital
Stay Only.
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Retrospective Acute Care Hospital
Stay Plus Post-Acute Care
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Retrospective Post-Acute Care Only.
Prospective Acute Care Hospital Stay