HomeMy WebLinkAboutMINUTES - 10071994 - 2.1 TO: BOARD OF SUPERVISORS
FROM: William Walker, M.D. _= Contra
Costa
DATE: October 7, 1994
County
SUBJECT: Increased Health Care Access for East and West County Poor Patients
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
(1) Acknowledge the County desires to enhance the access to health care for its poor patients who
reside in the east and west regions of Contra Costa County and to provide those poor persons in the east
and west regions of the County the ability to choose local hospital care in the County region in which they
live.
(2) AUTHORIZE the Health Services Director or his designee to execute a Contract with Brookside
Hospital to provide for hospital services for Contra Costa Health Plan and Basic Adult Care program
referred patients, at'an all-inclusive rate per day and outpatient visit. Staff or other privileges accorded
county-employed physicians under such contract shall be limited solely to those privileges necessary for
them as county physicians to provide medical care to Contra Costa Health Plan and Basic Adult Care
program members.
(3) AUTHORIZE the Health Services Director or his designee to execute a Contract with Delta
Memorial Hospital to provide for hospital services for Contra Costa Health Plan and Basic Adult Care
program referred patients, at an all-inclusive rate per day and outpatient visit. Staff or other privileges
accorded county-employed physicians under such contract shall be limited solely to those privileges
necessary for them as county physicians to provide medical care to Contra Costa Health Plan and Basic
Adult Care program members.
BACKGROUND:
On August 16, 1994 your Board authorized the Health Services Director to execute contracts with Delta
and Brookside Hospitals to enhance the access to hospital care for poor patients who reside in the east
and west regions of Contra Costa County.
The authorization included a maximum contract payment limit;of $750,000 for Brookside and $500,000
for Delta. e�fgJ
CONTINUED ON ATTACHMENT: YES SIGNATURE
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON October 7 , 1994 APPROVED AS RECOMMENDED X OTHER
IT IS BY THE BOARD ORDERED that the above recommendations are APPROVED:
See supplemental Board Order for additional action.
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS (ABSENT 1 AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
Contact Person:
CC: Health Services Department ATTESTED October 7 ,PHIL BATCHELOR, CLERRKK OOF F THE BOARD OF
County Counsel
SUPER ORS AND COUNTY ADMINISTRATOR
BY a ,DEPUTY
z
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During contract negotiations with both institutions, the maximum payment limit became problematic due
to: (1) The contract term and; (2) the potential for substantial growth in the Contra Costa Health Plan
and resulting need for inpatient services, created by implementation of the State's two-plan Medi-Cal
model, which could have a material effect on the need for inpatient hospital services.
Accordingly, a revised payment method,utilizing an all-inclusive rate per inpatient day; a five year contract
term; and a sixty (60) day cancellation provision, with no maximum payment limit, were agreed upon.
FISCAL EMPACT•
The net cost to the County, if any, is variable and dependent upon the following factors:
(1) Health Plan Growth: Increased growth in the Health Plan due to an expanded provider network,
i.e., Brookside and Delta, would be a positive factor; an increase of 1,000 Medi-Cal members would result
in approximately $1.1 million in gross revenues; expenditures for inpatient care rendered in non-County
facilities would range from $250,000 - $350,000 with the net differential available for outpatient and physician
services.
(2) Patient Choice: The number of patients electing to utilize Brookside or Delta versus Merrithew is
unknown. In the event there is no Health Plan growth and patient volume declines at Merrithew, the cost to
the County is the difference between the Hospital Contract rate and the variable cost savings at Merrithew.
The range for the increased cost/exposure to the County is approximately $350,000 - $650,000.
Attached you will find supplemental material which will be utilized in our presentation.
increased Health Care Access
for East and.West County
:Poor Patients
SUMMARY OF CONTENTS
■ Previous Board Actions
■ Expanded Transportation
• Status of implementation
• Financial Impact
■ Increased Hospital Choice
• Status of Contract Negotiations
-Sole Outstanding Issue
-Staff Recommendation
• Financial Impact of Hospital Services
-Factor One
-Factor Two
-Probable Case Scenario
• Key Contract Provisions
PREVIOUS BOARD ACTIONS
• On August 16, 1994 the Board voted to:
1) Improve the Patient Transportation System;
2) Increase Health Care Access for poor patients in East and West
County.
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SPECIFIC BOARD ACTIONS OF AUGUST 16. 1994 RELATED TO
EXPANDED TRANSPORTATION:
• Increased the number of buses providing shuttle service between
Merrithew Memorial Hospital and the Richmond and Pittsburg Health
Centers.
• Provided that the bus service will be available to all county patients.
• Provided that the bus service will be available to friends and family
members of patients.
• Provided a public education program for poor residents of East and
West County about the improved transportation services.
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STATUS OF TRANSPORTATION IMPLEMENTATION
0 The contract with the United Council of Spanish Speaking
Organizations was amended.
• Expanded Transportation Services began on September 1, 1994.
• Transportation trips have been Increased from 10 runs per day to 42
runs per day.
• Notification of transportation service availability is posted In every
County clinic.
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FINANCIAL IMPACT
TRANSPORTATION
• The United Council of Spanish Speaking Organization's 1994/95
contract was for $120,000.
• The contract was Increased by$120,000 to a new annual payment limit
of $240,000.
• Costs associated with education & notification effort were less than
$10,000.
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SPECIFIC BOARD ACTIONS OF AUGUST 16, 1994 RELATED TO
INCREASED HOSPITAL CHOICE:
0 Authorized contract with Brookside Hospital with a payment limit of
$750,000.
• Authorized contract with Delta Hospital with a payment limit of
$500,000.
• Authorized payment rates for CCHP referred services as follows:
Fee-for-service rates for similar services under the Medi-Cal
program.
The Hospital's Medi-Cal rate.
The average Medi-Cal statewide contract rate.
A contract rate negotiated between Contra Costa County and
the Hospital.
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STATUS OF HOSPITAL CONTRACT NEGOTIATIONS
• Contract negotiations with Brookside and Delta were completed by
staff.
• The payment rate per day has been agreed upon in accordance with
the.Board's direction of August 16, 1994.
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SOLE OUTSTANDING ISSUE
• The Board action of August 16, 1994, based upon staff
recommendation, included a maximum annual contract payment limit.
• This payment limit has created difficulties due to:
Restricted flexibility of County to implement Medi-Cal Managed
Care.
Desire of parties to forge a more long-lasting contractual
relationship.
Risk of rendering care without ability to receive payment.
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STAFF RECOMMENDATION
• Staff concurs with Brookside and Delta Hospital and recommends that
the August 16, 1994 Board authorization be modified to:
1) Remove payment limits;
2) Approve 5 year term with mutually agreed upon cancellation
provisions.
*Note: Numerous health care contracts exclude payment limits (e.g.
pharmacy, M.D.$)
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FINANCIAL IMPACT
HOSPITAL SERVICES
• Two factors define the parameters of material financial exposure and
opportunity for the County.
• Factor one Is the potential for Increased membership In the Contra
Costa Health Plan.
• Factor two is the potential for loss of days at Merrithew.
• The most probable scenario is a combination of both factors.
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FACTOR ONE
ASSUMPTIONS
• The Health Plan experiences a growth in membership due to either: a)
the expanded choice option for members; or b) by virtue of the two-
plan model.
• The increased membership will result in a growth in revenues coupled
with a need for Increased access to regional hospital beds.
0 Existing Health Plan members will continue to use Merrithew Memorial.
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FACTOR ONE
ESTIMATED IMPACT
Annual Membership Increase 1,000
Annual Revenue $1,080,000
($90 premium x 12 mos. x 1,000)
Less: Hospitalization
at Brookside and Delta * <$ 350,000>
M.D.'s, Ancillaries,
Outpatient Care, etc.t <8 600.000>
Operational Surplus at
1,000 Members $ 130.000
* Day usage per state and CCHP Medi-Cal utilization pattern.
t Based on historical usage.
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FACTOR TWO
ASSUMPTIONS
• The Health Plan experiences no growth in membership and the Contra
Costa Health Plan (CCHP) referred services currently provided at
Merrithew are now provided at Delta and Brookside.
• A decrease in CCHP East and West County referred services, would
result in a payment to the providing hospital at the contract rate with
an offsetting savings of the variable cost at Merrithew.
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FACTOR TWO
ESTIMATED IMPACT
Number of Days of
Referred Care Assuming
85% Of All Patients
Choose Brookside/Delta* 1,200
Blended Contract Rate 800
Amount Payable $ 960,000
Less Variable Cost
Savings e.g., Nursing/
Ancillary, etc. $<420,000>
($350 per day X 1,200)
County Cost Impact $ 540.000
*Days based on historical usage; percentage is an estimate.
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PROBABLE CASE SCENARIO
ASSUMPTIONS
• The probable short-term result of an expanded regional CCHP provider
network is a modest drop In volume at Merrithew, coupled with a minimum
2,000 membership gain in the CCHP Medi-Cal market.
*Note: 92,000 Medi-Cal eligibles/CCHP enrollment = 11,000.
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PROBABLE CASE SCENARIO
ESTIMATED IMPACT (Results over the next 9 - 12 months)
Operational Surplus
From Health Plan
Membership Increase
($130,000 x 2) $ 260,000
Volume Loss: Variable
Cost Savings Vrs.
Contract Payment Rate $<360,000>
Anticipated Cost Increase JA00 000
*Assumes 65% choice rate/$400 variable cost.
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KEY CONTRACT PROVISIONS
CONTRACT BROOKSIDE DELTA
Term: 5 Years ,/ ✓
Cancellation: 60 Days Without Cause ✓ ✓
30 Days With Cause ✓ ,/
Utilization Review/Quality
Assurance Program ✓ ✓
Authorization Requirements ✓ ,/
No Volume Guarantee ✓ ✓
Non-Exclusive ✓ ✓
Standard Insurance Requirements ✓ J
Services:
Medical/ICU ✓ ,/
Burn J NO
Skilled Nursing J NO
Outpatient ✓ ✓
Rates: Consistent with
Board Direction ✓ ✓
Professional Services Development J NO
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THE BOARD OR SUPERVISORS OF
CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on _ Friday, October 7, 1994_ by the following vote:
AYES:
NOES:
(See Below for vote)
ABSENT:
ABSTAIN:
SUBJECT: Increased Health Care Access for East and West County
Poor Patients
The Board deferred to this day consideration of the
recommendations of William Walker, M.D. , Medical .Director, that
provided for increased health care access for east and west
County poor patients and included proposed contracts with
Brookside Hospital (West County) and Delta Memorial Hospital
(East County) for hospital services for Contra Costa Health Plan
and Basic Adult Care program referred patients.
Following a presentation of Dr. Walker, the following
persons spoke in support of the recommendations under
consideration:
. Maria T. Viramontes, 2037 Coalinga Avenue, Richmond;
Jacque Salvador, (Local 1) , 2222 Golf Club Road,
Pittsburg;
. Susan Prather, 1019 MacDonald Avenue, Richmond;
.Henry L. Clarke, (Local 1, ) no address given;
, Marie Goodman, 3331 Brookside Drive, Martinez; and
, William Swenson, Local 2, 597 Center Avenue, Martinez .
.Grace Ellis, (no address given) , spoke in opposition to
the proposed contracts.
All persons desiring to speak were heard.
In its discussion on the recommendations of Dr. Walker,
Supervisor Powers expressed his support for the proposed
contracts, and particularly the contract with Brookside Hospital,
since it would provide access to West County patients as well as
allow the Contra Costa Health Plan (CCHP) to recruit and expand
not only for Medi-Cal patients but private pay patients as well.
He requested M. Camhi, Director of the CCHP, to report to the
Board at some future time on the outreach program in marketing
the CCHP in West and East County to the private pay patients,
small businesses, etc.
Supervisor DeSaulnier referred to actions approved by the
Board on September 13 , 1994, on which there was no apparent
response to the action for hiring an outside hospital consultant
to provide a cost benefit analysis of all of the hospital options
and for the Ad Hoc Committee to begin to talk to the court .
ordered receiver of the Los Medanos Hospital to discuss various
options for the County to purchase that facility. Supervisor
DeSaulnier noted that he, Supervisor Torlakson, and staff have
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met separately with the receiver without success. Supervisor
DeSaulnier suggested that discussion of these issues be included
on the agenda this day.
Therefore, on motion of Supervisor DeSaulnier, seconded by
Supervisor Torlakson, the Board by the following vote found that
the need for discussion on the issues presented by Supervisor
DeSaulnier arose after the agenda was posted and agreed to
include them in the discussion this day:
Ayes: Supervisors Smith, Bishop, DeSaulnier, Torlakson,
Powers
Noes: None
Phil Batchelor, County Administrator, advised that staff
has no thought of ever terminating negotiations for the County's
acquisition of the Los Medanos facility. However, Mr. Batchelor
pointed out that in the original detailed proposal presented to
the Los Medanos receiver, never once did the County get a
counterproposal in writing on any single point presented in its
proposal. He noted that all the County was given was oral
encouragement until it was learned that the receiver was going to
market the facility for a better deal. Mr. Batchelor concluded
by advising the Board of his commitment to continue to work on
the acquisition of the Los Medanos Hospital as a County facility.
Supervisor Torlakson expressed his interest in working
with Supervisor DeSaulnier on the acquisition of the Los Medanos
facility and the development of a new offer or proposal for
presentation to the receiver. He commented on the concerns of
the Pittsburg community relative to its obligation for the bonded
indebtedness of the Hospital District should the Los Medanos
Hospital become a regional facility.
Supervisor Smith referred to his position as a physician
in the County Health Services Department and to accusations in
the past of his having conflicts of interest with various issues
associated with Health Services. He advised that part of the
delay in acting on the recommendations presented this day was to
give him an opportunity to review all of the details of the
proposed contracts with his own private attorney and also with
County Counsel to insure that there is no conflict of interest to
preclude him voting on them. Finding none, he advised that he
would be voting for them.
Supervisor Smith then moved that the three recommenda-
tions of staff be approved with the inclusion of another (No. 4)
to authorize the Ad Hoc Committee (Supervisors DeSaulnier and
Torlakson) to discuss whatever issues they think are pertinent
with the Los Medanos Hospital Board and the receiver, that the Ad
Hoc Committee be authorized to hire whatever consultants they
think are appropriate at a reasonable cost (to be determined by
the Committee and staff) to find out whatever independent
information they feel is appropriate and report back to this
Board of Supervisors with that information.
The motion was seconded by Supervisor Torlakson.
Supervisor DeSaulnier advised that even though he agreed
with the intent of the motion, he would prefer that it be more
specific and therefore recommended the inclusion of the text of
recommendation No. 3 on the September 13, 1994, Board Order for
an outside hospital consultant for the Board of Supervisors
consideration to give a cost benefit analysis of the identifiable
options regarding longterm health care.
Supervisor Smith advised that he could not support the
expansion of the motion as recommended by Supervisor DeSaulnier.
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Supervisor Torlakson requested that Supervisor Smith's
motion be clarified to include direction to meet with the Los
Medanos receiver and that County staff explore the legal steps
that the Board of Supervisors or the Los Medanos Hospital
District Board of Directors may take to relieve the taxpayers in
that District of the bond payments or of financial arrangements
through the County's proposed lease proposals that might
accomplish this.
Supervisor Smith consented to Supervisor Torlakson's
amendment to his motion.
The vote on Supervisor Smith's motion as it pertained to
Recommendation No. 4 as amended by Supervisor Torlakson was as
follows:
Ayes: Supervisors Smith, Bishop, DeSaulnier, Torlakson,
Powers
Noes: None
On motion of Supervisor DeSaulnier, seconded by Supervisor
Bishop, the Board approved by the following vote the inclusion of
Recommendation No. 3 of the September 13 , 1994, Board Order
providing for an outside hospital consultant to give the Board a
cost-benefit analysis of the identifiable options for replacing
Merrithew Memorial Hospital:
Ayes: Supervisors Bishop, DeSaulnier, Torlakson, Powers
Noes: None
Abstain: Supervisor Smith
The Board then unanimously approved the three recommenda-
tions of Dr. Walker as set forth in a separate Board Order.
1 hereby certify that this is a true and correct copy of
an action taken and antered on the minutes of the
Boarf+of Supervisors on the date shown.
cc: M. Finucane ATTESTED: z / of 5/_
W. Walker M.D. PHIL BATCHELOR,Clerk of the Board
of Supervisors and County Administrator
F. Puglisi
M. Camhi -y�
County Administrator -.—,Deputy
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