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HomeMy WebLinkAboutMINUTES - 06111996 - D2 f = F Contra TO: BOARD OF SUPERVISORS Costa County FROM: William Walker, M.D., Health Services Director DATE: June 5, 1996 SUBJECT: STATUS OF PROVIDER AFFILIATION AGREEMENTS SPECIFIC REQUEST(S) OR RECOMMENDATIONS) & BACKGROUND AND JUSTIFICATION RECOMMENDATION: Accept report from the Health Services Director on the status of provider affiliation agreements and the implementation of the Medi-Cal Managed Care Initiative. BACKGROUND: As you are aware, health care is undergoing a significant transformation throughout the United States; it is very evident in California where mergers are announced almost weekly. In the Bay Area, Kaiser has announced that it will not replace its Oakland facility and will contract with Summit, Childrens and Alta Bates hospitals for service to the Kaiser members in Alameda County. Kaiser has also submitted a Request for Information (RFI) regarding affiliations with health care providers to operate their recently opened, brand new state-of-the-art facility in Richmond. Brookside has made it public that it is attempting to affiliate with another organization as part of their survival strategy. In Central County, we all read of the proposed merger between John Muir and Mt. Diablo Medical Centers. Of course, in East County, the Los Medanos saga continues to play itself out. With this as backdrop, I thought it important to bring the Board up-to-date on the Health Services Department's activities regarding affiliation and partnership arrangements as it relates to the implementation of the State's Medi-Cal Managed Care Two-Plan Model. CONTINUED ON ATTACHMENT: YES SIGNATURE: v ` � RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURES) ACTION OF BOARD ON June 11, 1996 APPROVED AS RECOMMENDED X OTHER X Supervisor DeSaulnier REQUESTED the Health Services Director to provide quarterly reports to the Board on the status VOTE OF SUPERVISORS of these issues. I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT B;shdp__) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE ABSENT: ABSTAIN: BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact Person: William B. Walker, M.D. Phone#: 370-5007 CC: Health Services Administration ATTESTED June 11, 1996 County Administrator PHIL BAT R, CLERK OF THE BO F SUPE S AND COUNT INI TOR BY 2 East County We have had several conversations and meetings with representatives of the Los Medanos Community Hospital District Board, City of Pittsburg, Cal Mortgage, and attorneys for the Los Medanos Community Hospital District Board. As you are aware, we discussed our proposal to renovate the first floor of the Los Medanos Community Hospital and to relocate our primary and specialty care services from the Pittsburg Health Center site to the Los Medanos campus. In addition, our proposal included a long-term leasing arrangement for Regency Hills Skilled Nursing Facility. We have been informed that Sutter/CHS has received a 90-day exclusive negotiation with the parties mentioned above to determine whether Sutter/CHS is interested in acquiring Los Medanos Community Hospital. Sutter/CHS is aware of our proposal and has scheduled a meeting with us on June 6th to discuss the concepts in greater detail. Central County As you know, we have had a long-standing working relationship with John Muir Medical Center. Indigent patients who are brought to their trauma center are transferred to Merrithew once stabilized at John Muir. This arrangement allows John Muir's trauma center to remain financially viable, and it insures that post-trauma hospitalization and outpatient care is provided to our indigent population. We have recently initiated a series of meetings with John Muir regarding the possibility of developing a relationship for high-risk maternal and neonatal transfers. Currently, all maternal high-risk transfers go to Alta Bates, and neonatal transfers to Childrens Hospital. Our proposal to John Muir is to use their high-risk and neonatal intensive care unit (similar to Alta Bates and Childrens Hospital) for our East and Central County patients. West County maternal and neonatal transfers will continue to go Alta Bates and Childrens respectively. In addition, we are discussing the possibility of having the John Muir perinatologists provide high-risk clinic services at Pittsburg and Martinez. These services are currently being provided by perinatologists from Summit Medical Center. This is a very exciting development, for it allows us to keep our East and Central County patients requiring tertiary care maternal and neonatal services in Contra Costa County. West County Brookside Brookside Hospital continues to struggle financially. They have announced their attempt to find a "suitor" that they could partner with, in a yet to be determined affiliation. Their Chief Financial Officer, and an investment banker (working on behalf of Brookside Hospital District), recently met with the County Administrator and Health Services Department staff. The Brookside representatives were inquiring as to the interest of the County in acquiring Brookside Hospital. The County Administrator and the Health Services Department will be reviewing the financial and programmatic material that Brookside has made available. It is clear that Brookside cannot sustain itself financially in the long-term without some affiliation or partnership. The Board is aware of our long-standing perinatal joint venture with Brookside that began in February 1991. In addition, in September of 1994, we established an inpatient medicine service. Given the uncertainty of the long-term viability of Brookside and the mandate for managed care access, Health Services staff have had discussions with Alta Bates Medical Center regarding including Alta Bates as an additional delivery site for our patients. Currently, our perinatal patients, seen at the Richmond Health Center, are offered Merrithew or Brookside as a delivery option. The majority of patients have elected to deliver at Brookside. We average approximately 30 deliveries a month, which represents approximately 40- 50% of the Brookside delivery census. (In contrast, Merrithew averaged 15 West County deliveries prior to the perinatal joint venture. 3 We currently deliver approximately 8 West County babies. These are mothers who choose Merrithew as their delivery site.) The medical staff involved in the perinatal joint venture feel very strongly we should offer Alta Bates as a delivery option for our West County patients. Alta Bates is staffed with in-house (24-hours per day, 7 days a week) nurse midwives for low-risk deliveries, obstetricians for complex deliveries, and perinatologists and neonatologists for high- risk deliveries. In addition, they have in-house physician anesthesia services. This is currently not available in community hospitals. Since February of 1991, we have been able to maintain a delivery on-call group for patients who choose to deliver at Brookside. Because of the increasing financial pressures that Brookside is undergoing, and the attendant tension that it creates among the Brookside medical staff, it is becoming very difficult to staff our on-call group. We likely will be eliminating the on-call service but our family practitioners who wish to continue their delivery privileges at Brookside may do so. In addition, our family practitioners may also apply for privileges at Alta Bates. Kaiser Richmond Kaiser's RFI went to Childrens, Summit, Alta Bates in Alameda County; Brookside, Doctors of Pinole and Health Services Department in Contra Costa County. We had a meeting with. Brookside to discuss their expressed interest in a joint submittal. Brookside did not have a specific programmatic proposal to put forward. The Department, therefore, submitted a letter of interest to Kaiser, commenting that our volume alone would be insufficient to sustain the Kaiser facility, but that we would be interested in partnering with any other hospital or health care system who would be interested in the Kaiser Richmond facility. We have had conversations with Alta Bates, and we both agree that an arrangement with each other would be of benefit to the West County Community. In summary, the health care landscape in Contra Costa County is changing very rapidly. The Health Services Department is attempting to keep all of its options open in order to meet the State's Medi-Cal Managed Care Program, as well as a long-term public policy perspective. We will continue to keep the Board updated as development occurs. FISCAL IMPACT: None.