Legislature(2011 - 2012)BUTROVICH 205
02/29/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska State Hospital and Nursing Home Association Representatives | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 29, 2012
1:36 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Kevin Meyer
Senator Fred Dyson
MEMBERS ABSENT
Senator Johnny Ellis
COMMITTEE CALENDAR
PRESENTATION: ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION
REPRESENTATIVES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
MIKE POWERS, Administrator
Fairbanks Memorial Hospital
Fairbanks, Alaska
POSITION STATEMENT: Presented information related to the Alaska
State Hospital and Nursing Home Association (ASHNHA).
PATRICK BRANCO, Past Chair
PeaceHealth Ketchikan Medical Center
Ketchikan, Alaska
POSITION STATEMENT: Presented information related to the Alaska
State Hospital and Nursing Home Association (ASHNHA).
ANNIE HOLT, Chair Elect
Alaska Regional Hospital
Anchorage, Alaska
POSITION STATEMENT: Presented information related to the Alaska
State Hospital and Nursing Home Association (ASHNHA).
RICK DAVIS, Administrator
Central Peninsula General Hospital
Soldotna, Alaska
POSITION STATEMENT: Presented information related to the Alaska
State Hospital and Nursing Home Association (ASHNHA).
MILLIE DUNCAN, Administrator
Wildflower Court
Juneau, Alaska
POSITION STATEMENT: Presented information related to the Alaska
State Hospital and Nursing Home Association (ASHNHA).
ACTION NARRATIVE
1:36:22 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:36 p.m. Present at the
call to order were Senators Egan, Dyson, Meyer, and Chair Davis.
^Presentation: Alaska State Hospital and Nursing Home
Association Representatives
Presentation: Alaska State Hospital and Nursing Home Association
Representatives
CHAIR DAVIS announced the business before the committee was a
presentation by the Alaska State Hospital and Nursing Home
Association.
1:36:52 PM
MIKE POWERS, Administrator, Fairbanks Memorial Hospital
presented information related to the Alaska State Hospital and
Nursing Home Association (ASHNHA). He introduced the members of
ASHNHA.
He recognized health care as an economic anchor in communities.
In the last 10 years, 10,000 jobs were added in health care in
Alaska. He shared statistics related to the numbers of members
in ASHNHA.
He thanked the committee for their support of training programs
at the University of Alaska. He stressed the importance of the
sacredness of hospitals due to births, passages, and deaths.
1:41:11 PM
MR. POWERS continued to discuss the economic anchors that health
care provides. He pointed out that Alaska is "beyond rural" when
compared to other states. The bed density is 3.4 patients per
1,000 square miles, which is important when considering
resources.
PATRICK BRANCO, Past Chair, PeaceHealth Ketchikan Medical
Center, presented information related to the Alaska State
Hospital and Nursing Home Association (ASHNHA). He commented on
the largeness of Alaska and the small population density.
MR. POWERS explained that one way Alaska deals with providing
health care to such a large area is by receiving a special
federal designation in the form of critical access hospitals,
tribal hospitals, sole community hospitals, and military
hospitals.
SENATOR DYSON asked what a tertiary hospital was.
MR. POWERS replied that it is the third level of care beyond
primary care, such as a center of excellence with specialty
areas. Alaska Regional Hospital is an example.
MR. POWERS continued to discuss critical access hospitals, which
are hospitals in a rural community area. He stressed the
economic importance of the hospital to its area. It is typically
limited to a bed size of 25 or less. There are 13 critical
access hospitals in Alaska and 50 percent of all Alaskan
hospitals are critical access.
MR. POWERS related that health care is a major employer in
Alaska. One out of every ten jobs in Alaska relates to health
care. The 2010 payroll was $1.53 billion.
He pointed out that half of all health care employment is in
hospitals and nursing homes; 40 percent in hospitals; 32 percent
in doctor's offices; 11 percent long-term care.
1:46:01 PM
He noted that health care employment is throughout the state
with the bulk of it being in Southcentral Alaska.
He said that health care costs impact health care facilities.
Health care costs tend to run about 135 percent of the U.S.
average, according to the cost of living index. Alaska's
hospital costs run about 38 percent higher than the national
average.
MR. POWERS addressed the cost drivers that impact the cost of
health care in Alaska. He said that Alaska pays more for health
care practitioners than eight comparison states. He stressed the
importance of education programs to help address this higher
cost.
1:48:29 PM
MR. POWERS spoke of "The Silver Tsunami," a challenge of the
tremendous growth of Alaska seniors who are large consumers of
health care services. He addressed the fact that some patients
must travel far distances to receive care, especially trauma
care.
SENATOR DYSON asked what AMI is.
MR. POWERS said it was acute myocardial infarction.
He continued to say that hospitals must serve all who need care.
The total for uncompensated care in 2009 was $178 million.
1:50:41 PM
MR. BRANCO related information about PeaceHealth Ketchikan
Medical Center. He said he changed the hospital from an acute
care hospital to a critical access hospital. He listed the
communities that the Medical Center serves.
He discussed the economic impact to Ketchikan of the Medical
Center's payroll of $28 million a year. He listed the special
challenges of the Medical Center, such as physician recruitment,
shipping logistics, the fact that it is a rainforest, first year
turnover, workforce availability and skill levels, and
competition with Seattle.
MR. BRANCO pointed out that PeaceHealth is a member of
HealthStrong, and is the sixth strongest critical access
hospital in the nation. He showed a picture of the new building
which will shift services to out-patient care.
1:56:29 PM
MR. BRANCO talked about physician integration. He recalled that
Ketchikan had very few specialists years ago. He related how the
hospital integrated practices.
SENATOR DYSON asked if doctors are burdened by high costs of
liability insurance.
MR. BRANCO said they are. He spoke highly of tort reform as a
recruiting tool.
SENATOR DYSON asked if doctors moved their practices under the
hospital's umbrella due to high insurance costs.
MR. BRANCO said it was not the primary factor; reimbursement
from Medicare was the main reason for doctors' moving their
practices.
SENATOR EGAN asked if there was a problem in Ketchikan
recruiting nurses with degrees.
MR. BRANCO said no.
SENATOR EGAN thought there was a 2-year delay for students who
want to enter the nursing program.
MR. BRANCO replied that he has been fortunate to be able to
recruit new nurses. He explained the supervision needed for
training new hires.
2:02:09 PM
ANNIE HOLT, Chair Elect, Alaska Regional Hospital, commented
that experienced nurses were retiring and there was a lack of
nursing instructors.
SENATOR EGAN spoke of changes in Medicare affecting the health
care profession.
MR. POWERS said that Medicare represents about 35 percent of
health care business. In Phoenix that figure would be 70 percent
to 90 percent. Most hospitals are aiming to break even on
Medicare, which is a huge challenge in Alaska. For those who do
not break even, costs will be shifted to "the commercial side."
SENATOR EGAN asked for clarification of "the commercial side."
MR. POWERS defined it as a surcharge or cost shifting to the
commercial payers.
2:04:15 PM
SENATOR MEYER said health care costs are 38 percent higher in
Alaska. He asked if Alaska is reimbursed for Medicare at the
same rate as Arizona is.
MR. POWERS explained that in Fairbanks, Medicare is reimbursed
at a higher rate than Phoenix because it has a "sole community
rural referral status."
SENATOR MEYER asked if Fairbanks is being reimbursed 38 percent
more than Arizona is.
MR. POWERS said clearly not; maybe 5 percent more.
MR. BRANCO pointed out that there is a disparity in Medicare
reimbursement across the nation.
At Ease from 2:06 p.m. to 2:09 p.m.
2:09:04 PM
MR. POWERS called Fairbanks Memorial Hospital a sole community
provider in a vast area with 1,350 employees. He said that the
top diagnoses were normal deliveries, psychoses, alcohol abuse,
and pneumonia. He spoke of the economic impact, challenges, and
sources of pride for the hospital. He talked about the problems
of "niche" providers, assisted living, chronic inebriates, and
aging surgery facilities.
MR. POWERS addressed the physician integration issue. He said in
the last five years 55 physicians were recruited to Fairbanks.
There is an on-going dialogue with independent physicians who
are not affiliated with the large multi-specialty clinic, the
Tanana Valley Clinic.
SENATOR EGAN asked how many beds Fairbanks Memorial Hospital and
Tanana Clinic have.
MR. POWERS said the hospital is licensed for 155 acute beds and
90 long-term beds. Tanana has no beds, but 45 providers.
SENATOR EGAN asked where 4-year nursing degrees are offered.
MR. POWERS said they were offered at UAA.
SENATOR MEYER asked about behavioral health positions.
MR. POWERS replied that it was a challenge to keep independent
psychiatrists in Fairbanks. He spoke of the "Juneau Model" for
retaining staff.
SENATOR MEYER suggested having a psychiatric residency program.
MR. POWERS said that was a $75,000 request this year. He
stressed the importance of providing residency settings.
SENATOR MEYER inquired if Providence was the only hospital with
a residency program.
MR. POWERS explained that Fairbanks was currently going through
a feasibility study to be jointly accredited by WAMI and Pacific
Northwest for a doctor of osteopathic medicine residency
program.
SENATOR MEYER suggested having residency programs for other
health care positions.
2:16:32 PM
MS. HOLT related information about the Alaska Regional Hospital
(ARH), which provides inpatient and outpatient care for all
surgical and medical specialties. She said that the primary
service area is Anchorage. ARH is the second largest hospital in
Alaska and has 832 employees. She detailed the economic impact
of ARH.
She listed sources of pride for ARH: a community partner for 49
years, rated #1 in Alaska in orthopedic services, joint
replacements, and spine surgery, meets all national quality
standards for patient care, hospital-based fixed wing air
ambulance program, certified cancer program, and first certified
stroke center in Alaska.
MS. HOLT listed ARH's goals going forward: enhancement and
expansion of core services, continued free public services such
as health fairs and monthly health education programs,
partnerships with non-profit community providers such as Alaska
Medicare Clinic and Anchorage Neighborhood Health Center, and
Alaska Regional employee health clinic opening in 2012.
SENATOR EGAN asked who contracts for treatment of Pioneer Home
patients.
MS. HOLT explained that there is a contractual arrangement for
each agency, such as the jail or skilled-nursing facilities. If
patients can't pay, funding is found.
SENATOR EGAN asked if ARH holds contracts.
MS. HOLT gave an example of ARH having the contract for the
Department of Corrections.
2:23:02 PM
MR. POWERS pointed out that a Pioneer Home resident would be
covered by Medicare.
MS. HOLT said ARH collaborates with Providence and other
hospitals.
SENATOR MEYER thanked ARH for its support for the Medicare
clinic. He was glad to hear that the numbers were up at the
clinic. He noted that the Alaska Neighborhood Health Center
moved downtown. He wondered if Medicaid reimbursement would be
adequate for that location.
MS. HOLT described Alaska's Medicaid plan and positive impact on
access.
SENATOR MEYER noted the problem of recruiting locum tenen
psychiatrists for winter employment. He asked if North Star is
used by ARH for psychiatric services.
MS. HOLT related that North Star is an adolescent facility and
ARH works closely with them as well as with Alaska Psychiatric
Institute because ARH does not have a behavioral health program.
2:28:39 PM
MR. POWERS described behavioral health care program struggles in
Fairbanks. He opined that the psychiatrist residency program
will help to solve many problems. Another effective strategy is
to provide an excellent benefit package and schedule in order to
attract psychiatrists to the area.
SENATOR MEYER pointed out that those doctors are often not
Alaskan residents.
MR. POWERS countered that the psychiatrist residents would be
Alaskan residents.
2:30:06 PM
RICK DAVIS, Administrator, Central Peninsula General Hospital
(CPGH), shared statistics about the hospital, which has 49 acute
care beds, eight outpatient clinics, and 60 long-term care beds.
The hospital has 720 employees and 50 active medical staff, 25
of which are independent physicians. He related that the
hospital serves mainly Kenai Peninsula Borough residents.
MR. DAVIS spoke of sources of pride and special challenges. CPGH
is a community-owned facility with community pride. One
challenge is from competing entities moving in, such as an
ambulatory surgery center, an off-site cancer center, and an
outpatient imaging center.
MR. DAVIS shared CPGH's goals: preparing for health care reform
by clinically integrating 25 employed physicians, hardwiring
quality and patient satisfaction processes, implementing an
electronic health record, and exploring contracting
possibilities beyond hospital-only services.
MR. DAVIS explained the Affordable Care Act and value-based
purchasing. In January of 2011, the Centers for Medicare &
Medicaid Services officials established value-based purchasing
incentives for hospitals by identifying measures in five
categories in order to generate payments after October 1, 2012.
He addressed two specific categories of value based purchasing:
quality of care and patient satisfaction using HCAPS surveys.
MR. DAVIS listed the eight core measures and the current pay for
performance pieces. He maintained that core measures are
important because they reflect evidence-based standardized care
and are associated with better outcomes.
2:37:25 PM
MR. DAVIS showed a graph of CPH's compliance with Perfect Care
scores.
MR. DAVIS discussed perspectives from the patient's experience,
which were based on Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) scores. He addressed strategies
CPGH uses to improve patients' experience. He presented a graph
showing the percentage of patients rating the hospital a 9 or a
10.
MR. DAVIS listed the awards and recognition Central Peninsula
General Hospital has received.
SENATOR MEYER asked if CPGH is known for the number of fish
hooks it has removed from patients.
MR. DAVIS said it is.
2:41:45 PM
MILLIE DUNCAN, Administrator, Wildflower Court, shared the
uniqueness of Wildflower Court, a non-profit organization which
was first formed in 1977. She described the population that
Wildflower Court serves; a younger and more physically capable
population than state and national averages. She shared a graph
showing that 66.5 percent of admissions are for rehabilitation
and 55 percent are discharged home.
MS. DUNCAN explained the economic impact to Juneau from
Wildflower Court. There are 57 beds and 105 employees, $6.7
million in wages and benefits, and $172,000 in professional
contract services.
MS. DUNCAN spoke of special challenges, such as the complexity
of resident conditions, the growing number of residents with
mental health diagnosis, and the difficulty of providing quality
of life for a relatively young population.
2:46:54 PM
MS. DUNCAN shared a source of pride in the number of awards
Wildflower Court has received. It also has future goals to
obtain the Malcolm Baldridge Quality Award, the Workplace Award,
and the Employer of Choice Award. She stressed the importance of
the process it takes to achieve these awards.
MS. DUNCAN shared a definition of today's nursing homes. Present
day nursing homes have evolved into highly skilled medical
centers serving populations with complicated health issues
needing treatment for longer periods than what is practical in a
hospital.
MS. DUNCAN spoke of some of the challenges confronting today's
nursing homes: providing quality of life for younger patients,
dealing with complex mental health behaviors, keeping patients
with acute conditions in the nursing homes, rather than
hospitalizing the resident.
2:50:25 PM
MR. POWERS thanked the committee.
CHAIR DAVIS thanked the presenters. She said she was interested
in learning more about the hospital's role in the Affordable
Health Care Act.
MR. BRANCO explained that all hospitals are involved in quality
programs that will help address the issues surrounding the
Affordable Health Care Act. Hospitals will have to work
collaboratively, and have a quality care focus. He emphasized
that the bottom line is that it is all about the patients.
SENATOR MEYER thanked the presenters.
SENATOR EGAN appreciated the efforts of the presenters. He said
that Pioneer Homes are a big part of compassionate care.
2:53:36 PM
There being no further business to come before the committee,
Chair Davis adjourned the Senate Health and Social Services
Standing Committee at 2:53 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| AK State Hospital Nursing Home Assoc. Presentation.pptx |
SHSS 2/29/2012 1:30:00 PM |
lsncceh |