Loading...
HomeMy WebLinkAboutMINUTES - 02281984 - 2.4 ,To: .� BOARD OF SUPERVISORS FROM: M. G. Wingett, County Administrator Contra Costa DATE: February 22, 1984 @ Court/ SUBJECT: PENDING ASSIGNMENTS SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION: Acknowledge receipt of report from the County Administrator. BACKGROUND: On January 26, 1984, I reported to the Board on four pending assignments which we had hoped to have completed by the end of January. At that time, I requested continuation of the deadline on those four items until February 29, 1984. The four items and the current status of each are as follows: 1 . Review of eligibility charges to the Health Services Department from Social Services. On February 21 , 1984, Dr. Walker and Mr. Jornlin presented a status report on this subject and noted that a more comprehensive report would be presented to the Board on February 28. That report is listed elsewhere on this agenda and should be considered separately by the Board. 2. Review of Central Collections charges from Auditor-Controller to Health Services. As was noted on January 26, 1984, it does not seem feasible to alter the charges being made to Health Services in mid-year. This will be one of the items Nu-Med will take a close look at and will discuss in considerable detail with the Auditor- Controller in preparing the 1984-1985 budget. No further action is anticipated on this item for the current fiscal year. 3. Review data relating to proposed closure of "C" Ward. 4. Review proposals to close patient clinics to all but Health Plan members. Attached is a report dated February 2, 1984 from Dr. Walker commenting on these latter two items. You will note Dr. Walker agrees with the analysis made by Dr. Stanger that if they were to close "C" Ward they would be in an overflow situation a good portion of the time thereby requiring that the ward be opened and closed frequently with fluctuations in census. The issue of which wards should remain open and whether any should be closed will be reviewed by Nu-Med. In the meantime, no further action should be taken on the closure of "C" Ward. Dr. Walker also comments on the conversion of the outpatient clinics to serve only Health Plan members. Dr. Walker's conclusion is that this matter also should be studied both by a staff task force and with Nu-Med in order to resolve a broader CONTINUED ON ATTACHMENT: X YES SIGNATURE: C Z&tel RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE X APPROVE OTHER SIGNATURE(S) )/ZI, ACTION OF BOARD ON eDrUdry e?5,6AV0q APPROVED AS RECOMMENDED �'_ OTHER VOTE OF SUPERVISORS UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD County Administrator OF SUPERVISORS ON THE DATE SHOWN. CC: Acting Health Services Director ATTESTED A,&d, _g 4 ?8 /984( County Welfare Director J.R. OLSSON, NTY CLERK Auditor-Controller AND EX OFFICIO CLERK OF THE BOARD 233 M3e2/7•e3 BY DEPUTY -g- range of policy issues relating to the future of the outpatient clinics. No further action should be taken on this proposal pending completion of the work of the task force and recommendations from Nu-Med. CLINIC CONVERSION TASK-GROUP REPORT The Task-group, which was assigned the responsibility of investigating the feasibility and desirability of converting the current structure of the Ambulatory Care Centers from a "fee-for-service" orientation to a "prepaid" orientation, has met numerous times, and has reached the following conclusions: 1 ) The original scope of the study is too limited in that it only deals with the financial impact on the ambulatory care system and not the entire health care delivery system of the County. 2) The requirement of a February 1 report and the selection of. a . management firm to begin work on February l make it unrealistic . to proceed further on this issue at this time. 3) The committee believes that the concept of converting "fee-for- . service" business to "prepaid" is indeed a valid one, certainly worthy of further investigation in the near future in concert with the management firm. 4) The "Clinic Conversion" project should be put on hold until such time as it can be included as part of a larger study which deals with the "fee-for-service/prepaid" issue The Clinic Conversion Task-group which has been considering this issue considers its work temporarily completed and is not anticipating any further meetings. January 31 , 1984 234 CONTRA COSTA COUNTY Contra Costa HEALTH SERVICES DEPARTMENT RLCEt�,RU°unty FEB - 71984 A OffiCe of Coon,.; Adn:inistrator To: Mel Wingett, Date: February 2, 1984 County Administrator From: William Walker, M.D. , W Subject: Report on Long Term Care Acting Director, Health Services Cne of the issues that was pending from an earlier Bielenson hearing was the closure of C Ward. When I met with you and Van regarding the - study of the C Ward closure I indicated I would be able to report back . to you by February 1; acoordingly,.the study is attached. Simply stated, the report by Dr. Stanger shows that if we closed C Ward we would be in an overflow situation (i.e. , the need to find more beds) a good portion of the time and, therefore, would find it necessary to be frequently opening and closing the ward to accmmodate the patients, thus defeating the purpose. The other issue from the Beilenson hearings had to do with the clinic conversion to only HMD patients. Dr. Tysell, Acting Executive Director for the HMD had a task force review the issue and has concluded that a broader range of policies is involved with this question arra, there- fore, ought to be studied with the new management firm. The task force's report is also attached. I will be transmitting other reports on the remaining long tern issues shortly. WW:GS:bgg attachments oc: Dr. Tysell Dr. Carr 235 A-41 3181 TWAL INPATIENT CENSUS DATA (MWnMY AVERAC ES) 1980 1981 1982 1983 January 150 163 135 136 February 151 169 133 121 March 153 163 133 128 April 149 158 133 120 May 150 138 130 117 June 142 141 124 120 July 150 146 130 127 August 142 144 132 118 September 156 142 111 118 October 151 141 108 November 150 142 120 Dece ber 151 137 124 r>, ` 236 • • n • • rt � �Trr Fav i • !aT 1'+Lsf � w \ ;as . Hr^rr` ,*"r'., • �'i+,`% �r dit'.' "�' �z�: fir: �r ., �; - • } y S �`� -'+ mit • ° ri ��� .� '- • � r:+€ `,fit "kz+'; � � %moi q�..i „ ''. • * i l ii i • i . � COST/BENEFIT OF PROPOSAL TO "CLDSE" AN INPATIENT WARD Potential Benefits Potential Costs & SAVINGS I. Dollar cost of opening and closing --decrease nurse staffing when overflow occurs --decrease ward clerks 2. Inconvenience/risk/cost of moving --decrease housekeeping costs patients and services --decrease utilities costs 3. The "lost or forgotten patient syndrome" --decrease other plant operation costs 4. Lass of nursing specialization orientation 5. Decrease in high visibility beds 6. Patient crowding in roans 7. Staff crowding (nurses, physicians, other' 8. Increased ambient confusion (noise, activity, etc.) 9. Impact on morale t. . 238 BEDS ON INPATIENT' WARDS B Ward Current maximum -- 46 beds If Hospice --- 42 beds C Ward General surgical ---�> 21 beds ICU/CCU -----> 6 beds PAR ---- 4 beds ICU Isolation ---� 1 bed Outpatient Recovery ---j 5 beds D Wand C HP ---�) 10 beds Peds/Gyn -- 24 beds Playrocm ? 2 potential beds 239 AVERAGE CENSUS BY SERVICE FOR FEBRUARY-SEPIEMBE 2 1983 B C(total) B+Cc?' Co D D D Peds D EM F&G February 23.3 16 10.4 33.7 5.6 4.4 10.0 2.4 7.4 12 March 31.3 14.2 9.3 40.6 4.9 5.5 10.4 3.1 8.0 11.8 April 30.7 16,8 10.1 40.8 6.8 3.8 10.6 1.3 8.2 10.4 May 28.6 15.7 8.6 37.2 6.5 4.5 11.0 3.0 7.7 8.5 June 29.7 17 11.7 41.4 5.2 5.1 10.3 2.0 7.2 8.8 July 31.3 14.1 9.7 41.0 4.4 4.9 ' 9.3 2.6 8.0 7.7 August 32.5 14.1 10.6 43.1 3.5 4.0 7.5 2.0 7.1 8.0 September 22.7 14 7.2 29,9 6.9 4.3 11.2 1.9 6.5 7,2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Average for 8 months 28,8 15.2 9.7 38.5 5.5 4.6 10.0 2.3 7.5 9.3 240 r. BED NEED AND OVERFU)W ESTIMATES ASSUMING POISSON DISMBUTION OF CENSUS For B average daily (NN) census Feb-sept 1983 = 28.8 Need 33-38 beds for 1/10 full occupancy (76-79% occupancy) -->9-58 days/yr overflow it 38-44 " 1/100 11 (66-68% 1-12 " " of 43-49 1/1000 " It (58-61% " ) ?t-2 For C (Total) average daily (PN) census Feb-Sept 1983 = 15.2 Need 21 beds for 1/10 full occupancy (71% occupancy)--*qP 30 days/yr overflow 26 " " 1/100 " If (58% 3 " 11 29 11 it 1/1000 it 11 (52% '3 For D (Gyn) average daily W census Feb-Sept 1983 = 4.6 Need 7-9 beds for 1/10 full occupancy (57-56% occupancy)-,j 8-25 days/yr overflow " 10-12 " If 1/100 " to (40-42% " 2-2 " If ' " 12-14 " " 1/1000 " (33-36% it )-j<i " ft r For D (Peds) average daily (MN) census Feb-Sept 1983 = 2.3 Need 5-6 beds for 1/10 full occupancy (40-50% occupancy) 7-9 1/100 (29-33% ) 9-11 " " 1/1000 " " (22-27% " ) If 4 beds available 20-64 days/yr overflow 11 5 11 11 7-31 11 11 t, 6 of of 2-13 t, 11 7It it !1_5 to n of 8 to u I. rye o n lex For B+C9"average daily (M) census Feb-Sept 1983 = 38.5 Need 44-49 beds for 1/10 full occupancy (80-82% occupancy) " 50-56 " " 1/100 If Is (70-71% it ) 56-62 to It 1/1000 " if (63-65% ) If 45 beds available 16-70 days/yr .overflow If 40 64-168 " 241 For Cq+ D(Gyn) average daily (MN) census Feb-Sept 1983 = Need 15 beds for 1/10 full occupancy (67% occupancy) of 19 it of 1/100 " of (53% it ) It 22 1/1000 (45% ) If 15 beds available ---� 18 days/yr overflow If 20 1 day/yr overflow If have (B+C61 on B Ward and (CV+Gyn) on D Ward: minimum bed need for 1/100 full occupancy, if separate services = 50 + 19 = 69 bed: if combined services = 62 beds Can, therefore, have sane 1/100 full occupancy 43 beds on B Ward for (B + C8) + 12 beds on D Ward for (C� + Dgyn) + 7 beds on D Ward as "swing beds" for B9 or (CY + Dgyn) r' �' 242 Table NS 1. Arlrrmining Bod Nt r•d (lom ( wspanc'y and cxwlti Figurrs N Num4+ul 11.•da In the Il.ihq' 1 2 3 4 5 5 7 6 0 IO -11 12 13 14 IS 2u •a f0 3! 1 F 30 7 •. • 7 217 119 53 20 7 2 • J 2:J 211 1111 64 31 IS 5 2 ' 4 33. 279 267 136 79 41 10 A 3 2 5 351 326 269 205 141 17 49 2S 12 5 2 1 6 35.1 311 310 26I IW IN 91 Sat 31 16 9 4 7 1 IF 6 3.4 3111 350 329 201 251 2110 I2U- 20! 147tt...' 161 662 ;1 41 24 13 7 4 Number of days per year an 0 • YJ 154 343 323 290 247 I09 151 106 72 46 27 13 9 • ad...6wu•tw can ege11 1,. ` 10 764 342 353 341 3111 2SS 244 Ina 151 111 77 MI 31 16 1 • ha•r an m-0h,eent ouml.t II • 361 IM 352 337 311 2At 241 196 ISI 114 PA 64 34 7 • of tech to mast ateda E 12 6 3113 356 349 331 IN 277 239 197 M 117 64 67 6 13 354 362 356 346 MO 305 274 237 Loi 154 119 67 10 14 • 31J 360 354 343 326 301 771 23S 103 157 121 IA 1 iS 364 SQ 359 351 340 322 246 266 731 196 IDA 11 3 • 10 4S 10 SS 60 65 70 73 60 6S W 6. 11p 1M II' 311 a • • a 364 362 359 351 111 321 309 161 41 3 • -- a 23 • • • 3W 363 361 357 26A 164 60 0 1 1n • • • 353 2!16 I1 L5 69 12 2 3S 364 $46 W 167 61 16 3 40 6 367 343 277 IAS 70 211 4 45 a 361 334 27: 169 75 .3 S 1 6e, • 360 334 266 169 TI 27 7 3 t 65 a 358 330 264 170 A: 30 a 3 69 364 350 32A 2ft 170 64 33 10 3 65 • 344 353 323 25% 171 90 3t 12 3 70 • 363 36: 320 25'1 17{ 92 In 13 4 1 75 • 362 3.50 316 2S4 177 to 12 15 3 1 90 • 3A1 31• 313 2SI 172 67 45 17 S AS • %W 34e. 710 250 171 IM .4: 1t1 60 264 339 711 SOA 24c K3 It: VI • 45 • 364 359 14: 3N'• •1j- 1:.1 1114 3 ' IW • 364 357 340 IN 245 1:3 9 ' Sown. "Drtvmir.iot Red\etch From Orrupanry and Cream F•twi-s. by Prrnon L.R're6 warlh.1'h.h.,/lopimJr.J.A.ILA..J•n.ur1 I,19(5,tbi./0. •Ina.-than ocr•ha!f day can be capeeted for all value,to the right. •$5S days ran be rtpreted for all talus beluw. i >• � •7' to t� n N n er t`.• cc N ^•f .r': tt '^ r7` O N tL•' C — t•1 rf5 O O — — N r^f •t d• u': s: n CC � N 4enm r .r a •r e` r7 �, n n � %0 :C •c nnnnn nnnr. � t •- cT. G C c rg a C O N N e7 O �^ V. N �O N N uj to pmp N ` CD O �• in •> t'7 tc n n cc 01 0) pp N n. < .Q' N tD tC to n n n n n n n n n n n n C co C S O N N _Q ami •i' J'i ti ti7i tD •ND t� t0 b t0 t0 n t~. n n 6p tC' OD aaD m aC ivo CSD is C5 CID m cc i t O v V v A p O - •� N N N N N N N M 'tl' a tl'7 tN.� •J ra. y 6 C4 C't � � � C4 N rh'1 i� n G' A .� C - - - - — •� - - N 4a1 V v to cc mpp r�4 p 1� CCpp v A — 6 n O) O N Oi to — — — N N N N N en M In tv0 I%D n CD a0 0) Ot O O C4 a CO 0% d� C^4Q� O an In 1z Cr) ozena L) Imy DC m0 to v^ 0) •n — tt CV ncnCom •t C_ '� `''— C 9 — — — — — N N of— N m � V. •r1 tC 1C t• n OD CO 0 O + - O aO — a E al 9 N 9 O p pp C pp O Co F ai a v a so Q N.an a N !D n Cr Ot O - N — — N N N N Ct+i d• � .r'! In 111 t� � n Co CSD 243 .. .,..--. .. - _ �....... �. tee.-.m m.-.-r_.a..a...-ew.+...»e..-._...-�. •v-.. ,._ �. .- - ..�._.��_.._._.. .� .. J A M Dv a ti:. a 40 M� - r 3 �-'1. ' I 1 Pb co .1% A= � � .� S � •aA � i r 1 z \ Luz N N .r _� .� fir .i + AIF 00 tA tzrz r cr� �° o x r PIZ b � v � ;z N" 2 0 s o 0 244 ,, N t ©15TRt$w'T+oN 6� fu hF4l4 Y (roto) Cc+iso Fox + gYrJ P/ILI �kR1iJ('? SCS-SEPT MRl y;9 gni '�� 14 �19 $/1 �It 41 9/13 L Yttf 7�ti4 blit �IG �ti �►t �q 4J'� 7j 1�9 F�tL 9/to 1l16 yi7 /zf tf q tf3� silt` 746 �1S %, 1/1, 'Igo Y:7 '1,7 7/15- '/13 % '/Jo %- Q/ 7/Z1 '77 q!1 j2 t s�9 Y1 444 �t '/17 '/?( 7/r "/t 7 �,j '/,1 d '/& Y-) 7/3 7IY sI1 �i7 4�S 1J'$ '/1 6!•7 pf �tt I7 tC ti36 M % 713'1 /Iz �t3 ;'�3 4 17 7i0 Els- Ij13 7It3 s/1. 1)11'4/ irJ fy 9y 71t, Lf1 ' 1 � 7 g/>t y2z Oso Cto lit ;T; 3 i7 t lit ,t 4!3 Uzi aj s1tY516 `/ 7/p -'� 3i r SI3 31, jsl. r 3/q S/z S s/b, Y 3/6 #/o tjS 2�z 3 3i, ;i7 t4) '112S Ylo 6/z 7i0SlII Vil i7 t14 "/4 3fo2� 4iLeft �rR 740 / �S J4 �1 tai X11 ly3 f�2 Zi4 j/O 1/1 :/P Yy iib y Jia "r Y4 �7 'Yy =ju '/i1 it Yt VV4 7f u o S to iS to c�Nst+s 245 v - DI-1) t r` e~ r J Ir js 7. tw crr rcl T i O fs t +' T j Ttr , • 4 - CA re CPO 2 r .+ r r r M + T r r U v � r r r' ab Qp el 0 r Y G, c •� qr' _� 7 F� �� N r� V 2 J eIr �r � a b%STP,0�,ATt0!`l OT Z3R ►Ly (mM ) CENSUS 'POSE rEDIATRICS 1�uR�NC> FEQ — SEpT Ig93 (Al So 3o 31 s lb 3 CENSLk S 247 CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT To: John Stanger, M.D. Date: August 4, 1983 From: Shirley Schremp, R.N. Subject: Utilization of Administ ator of Nursing B - C - D Nursing Administration Marj Wolf asked me to give you some idea of when it would no longer be cost effective to keep open a ward. I have discussed this with the three Assistant Directors of Nursing. We all agree that 10-12 is about the right number. With 10 patients, the nursing staffing would be: 1 DAYS PM NIGHTS k k 1 R.N. 1 R.N. 1 R.N. 2 L.V.N. 2 L.V.N. 1 L.V.N. With 12-15 patients it would be: (and this is minimal ) 1 R.N. 1 R.N. 1 R.N. 3 L.V.N. 3 L.V.N. 2 L.V.N. Anything more than that would increase the R.N. 's to two on Days and P.M. 's , and if there are a lot of I .V. 's , another R.N. for nights. It is extremely difficult to attach a cost savings to closing a ward. There are so many variables to consider that it becomes an im- possible task. However, the cost savings are definately there. What follows is an example of nursing savings: Unit N1 - 15 Patients Unit M2 - 15 Patients 11-7 7-3 3-11 11-7 7-3 3-11 1 R.N. 1 Supervisor I Clerk 1 R.N. I Supervisor 1 Clerk 2 L.V.N. 1 Ward Clerk 2 R.N. 2 L.V.N. 1 Ward Clerk 2 R.N. 2 R.N. 3 L.V.N. 2 R.N. 3 L.V.N. 3 L.V.N. 3 L.V.N. COMBINED WARD - 30 PATIENTS 11-7 7-3 3-11 SAVINGS 2 R.N. 1 Supervisor 3 R.N. 4 L-V-N- 1 Clerk 5 L.V.N. 1 Supervising Nurse 34,980 3 R.N. 2 Ward Clerks 32,184 6 I:V.N. 2 R.N. 59. 136 1 L.V.N. 199548 $14 �8 A-41 / 11 -34, 115 N • S h o- TO i 6 e: f-I J 57 ,[S v 1N i Y Y Q T %s J e: 1 V i 43 42; W O k T-2 0 T 1 � Z� 249 4 � o _1 ,n , J M _ O J r � x 41 00 46 ku 10 0 T N . jJU 250 T .. 4 t r y 4 '� E �• S t : s i r 401 rj 00 P N+ to -••' � O . to do k M 1 T :. £ d to o N d T 251 1 O CLINIC CONVERSION TASK-GROUP REPORT The Task-group, which was assigned the responsibility of investigating the feasibility and desirability of converting the current structure of the Ambulatory Care Centers from a "fee-for-service" orientation to a "prepaid" orientation, has met numerous times, and has reached the following . conclusions: 1 ) The original scope of the study is too limited in that it only deals with the financial impact on the ambulatory care system and not the entire health care delivery system of the County. 2) The requirement of a February 1 report and the selection of a management firm to begin work on February 1 make it unrealistic to proceed further on this issue at this time. 3) The committee believes that the concept of converting "fee-for- service" business to "prepaid" is indeed a valid one, certainly worthy of further investigation in the near future in concert with the management firm. 4) The "Clinic Conversion" project should be put on hold until such time as it can be included as part of a larger study which deals with the "fee-for-service/prepaid" issue The Clinic Conversion Task-group which has been considering this issue considers its work temporarily completed and is not anticipating any further meetings. January 31 , 1984 252