Rural Hospital Stabilization Program Overview

Rural Hospital Stabilization Presentation to: Senate Study Committee on Barriers to Georgians Access to Healthcare Presented by: Patsy Whaley, Executive Director, SORH 0 Date: October 16, 2017

Mission The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through planning, purchasing and oversight We are dedicated to A Healthy Georgia. 1

Rural Hospital Stabilization Title or Chapter Slide (use as needed; feel free to delete) Committee (RHSC) HUB AND SPOKE MODEL the right care, at the right time, in the right setting 2

Hub and Spoke FQHCs Technical Schools Board of Education Behavioral Health CAHs Home Health Public Health HOSPITALS EMS Physicians Nursing Homes Local Industry Tertiary Hospitals 3

Rural Hospital Stabilization 2014 Governor Deal announced the establishment of the RHSC 2015 Hub & Spoke model chosen determined to provide the most value to rural communities $3M in funding appropriated 4 pilot hospitals identified by the Legislature $750K awarded to each hospital Projects chosen & initiated 2016 $3M in funding appropriated Phase 2 hospitals chosen 4 chosen, 1 opted out Remaining 3 hospitals awarded $1M Projects chosen and initiated 4

Rural Hospital Stabilization 2017 $3M appropriated 12 Phase 3 hospitals chosen, one opted out $250K awarded to each hospital Education and training initiated and continuing Projects under development 5

Rural Hospital Stabilization Sites Towns Catoosa Fannin Rabun Dade Union Murray Whitfield Pilot FY16 Sites Appling HealthCare System Crisp Regional Hospital Emanuel Medical Center Union General Hospital Walker Gilmer White Stephens Lumpkin Gordon Chattooga Pickens RHSC Year 1 Banks Dawson Franklin Hart RHSC Year 2 Hall Forsyth Cherokee Floyd Bartow RHSC Year 3 Madison Elbert Jackson Polk Barrow Clarke Cobb Gwinnett Paulding Oglethorpe Oconee Haralson Wilkes Walton Lincoln DeKalb Year 2 FY17 Sites Habersham Medical Center Miller County Hospital Upson Regional Medical Center Fulton Douglas Greene Morgan Taliaferro Clayton Columbia Carroll Newton Henry Warren Fayette Richmond Coweta Jasper Putnam Heard Hancock Butts Spalding Burke Jefferson Pike Lamar Baldwin Meriwether Jones Troup Monroe Washington Year 3 FY18 Sites Bacon County Hospital Chatuge Regional Hospital Cook Medical Center Effingham Hospital Irwin County Hospital Jasper Memorial Hospital Liberty Regional Medical Center Memorial Hospital & Manor Mitchell County Hospital South Georgia Medical Center-Lanier Campus Washington County Regional Medical Center Upson Jenkins Bibb Wilkinson Screven Harris Johnson Crawford Talbot Twiggs Emanuel Peach Taylor Muscogee Laurens Bulloch Houston Bleckley Candler Effingham Marion Treutlen Chattahoochee Macon Schley Pulaski Evans Dodge Dooly Toombs Wheeler Bryan Stewart Chatham Tattnall Sumter Webster Wilcox Telfair Crisp Liberty Quitman Long Jeff Davis Appling Lee Terrell Ben Hill Randolph Turner Irwin Bacon Wayne Clay McIntosh Coffee Dougherty Calhoun Worth Tift Pierce Baker Early Berrien Atkinson Glynn Brantley Mitchell Colquitt Ware Miller Cook Lanier Seminole Camden Clinch Charlton Decatur Thomas Grady Brooks Lowndes Echols 6

RHS PROJECTS PHASES 1 & 2 EMS & ED Connectivity School-based Telemedicine Occupational Health Level 4 Trauma Designation Chest Pain Center Designation Onsite School Clinic Reduction in Readmissions within 30 Days Remote Stroke Center Designation Community Paramedicine Tele-nephrology Care Coordination Behavioral Health Housing to accommodate medical residents Reduction in non-emergency utilization of ED and EMS 7

RHS and APRNs Phase 1 (pilot) Planned utilization of APRN in Occupational Health Program, did not occur replaced with PA Use of APRN in skilled nursing facility (SNF) to facilitate improvement in overall health outcomes for residents & reduction in potentially preventable hospital readmissions Not supported by Medical Director Phase 2 Extended hours clinic employ 2 APRNs, one funded by the grant, one by the hospital. Results: June August 2017: Reduction in ED visits: 800, increase in clinic visits: 1,124, over the same period 2016 Geriatric Psych hiring a psych APRN Phase 3 Unknown at this time 8

CHALLENGES Community Education Physician Engagement Timely data Connectivity 9

HOSPITAL COMMENTS This has given us the ability to explore new strategies and care opportunities that otherwise might not have been an option due to lack of capital and risks. While some projects focus on reducing readmissions, they also enhance the level of care we provide our patients and improve their overall quality of life, which is our overall goal. The project forced me as a CEO to look at potential activities for the hospital that I would not have considered, ones which are either saving us money or generating additional revenue. One of our most valuable lessons has been communication and education regarding our local CSB. We didn t know them, and they didn t know us before now. We are working together for the benefit of our mental patients. I spoke in favor of using telemedicine to bring specialty care back to our community; however, I don t think I realized how far it could go. You need a physician champion. 10

INVITATION Rural Hospital Stabilization Committee Meeting Thursday, November 2, 2017 Georgia Public Safety Training Center Forsyth Phase 1 Outcomes Phase 2 Progress Phase 3 Introductions 11

Rural Hospital Stabilization Contacts Patsy Whaley, Executive Director, SORH pwhaley@dch.ga.gov - (229) 401-3081 Project Manager: Lisa Carhuff, Director, Hospital Services Lisa.Carhuff@dch.ga.gov - (229) 401-3092 12