Delaware Health Resources Board
Minutes of Meeting
Thursday, December 15, 2011
2:30 pm – 4:30 pm
Delaware Department of Transportation, Administration Building
800 Bay Road
Farmington/Felton Conference Room
Dover, DE 19901
Board Members AttendingStaff
Dr. Veronica Rempusheski, ChairJudith Chaconas
Sheila GrantFrancis Osei-Afriyie
Carolyn CaseyKelly Shaughnessy
Bettina RiverosErika Tross (DOJ)
John WalshCarol Schofield
William Love
Bedford Bruno
Mark Thompson
Suzanne Raab-Long
Kyle Hodges
Brian Posey
Faith Rentz
Call to Order
The chair called the meeting to order.
Conflict of Interest
No conflict of interest was declared.
Welcome & Opening Remarks
The chair welcomed the members of the board to the meeting.
Approval of the Minutes
William Love made a motion to approve both theregular meeting & executivecommittee meeting minutes fromNovember. Mark Thompson seconded the motion. The motion carried.
Conflict of Interest
None declared.
Update from Department of Justice
Erika Tross provided an update on the appeal of the Board’s decision on HealthSouth. The judge has decided to rule on the case and does not need to hear oral arguments. The time frame for the decision is unknown.
Ms. Tross has resigned her position as deputy attorney general effective January 13, 2012. Another DAG will be assigned to the Board.
Certificate of Public Review:
Initial Presentation: Nanticoke Health Services (11-005)- to add a second cardiaccatheterization lab
Nanticoke Memorial Health Services representatives presented the following information:
- Cardiology is our #1 Service line
•Critical for us to maintain a cardiovascular presence in the community we serve.
Why?
•Heart Disease is the nation’s leading cause of death in both men and women - Centers for Disease Control
•Delaware ranks 34th in the nation in Cardiovascular Disease - American Heart Association
•In 2010- Cardiovascular Disease cost $500 billion in medical expenses and lost productivity nation wide
SERVICE PROJECTIONS 2011 – 2017
Community Assessment
Service 2011 2013 2015 2017 Change
Cardiac Caths 574 642 713 787 +213
CARDIOLOGY PROGRAM
FY 2011
Additional cardiac-related services performed at NMH:
•Stress Tests – 1,155
•Nuclear Medicine Studies - 873
•Cardiac Pacers - 132
•Echo cardiology Studies - 3,434
Cardiology Gross Revenue Contribution - $9,889,072
JUSTIFICATION
To provide acceptable service to the community NMH must:
•Provide 24/7 365 Coverage
•Provide 2ndinterventionalist
•Provide Back Up for Existing Equipment
•Minimize or Eliminate Scheduling Conflicts
COST
•Estimated Cost for 2nd Cath Lab Addition
•Renovation to Existing Space - $600,000
•Equipment Acquisition - $1,200,000
•Total Project Cost - $1,800,00
STAFFING
•A second cath lab would add positions for new staff
•1 Additional RN
•1 Additional Technician
•1 Additional Interventional Cardiologist
The chair appointed the following members to review the application:
Mr. Brian Posey – Chair
Mr. Mark Thompson
Mr. Bedford Bruno
Decision: MeadowWood Behavioral Health System (11-003) – to add 20 inpatient beds.
Mr. Love on behalf of Ms. Noonan provided an overview of the review committee report on the application from MeadowWood Behavioral Health. The report was distributed to the Board prior to the meeting. The committee researched behavioral health issues in Delaware, reviewed literature and listened to testimony from the applicant, state officials and members of the public during its meetings. This request for additional inpatient psychiatric hospital beds in New Castle County is somewhat complicated. In addition to reviewing and considering data and population projections regarding current capacity, the impact of new psychiatric beds which have recently openedat the Rockford Center, changes occurring at Delaware Psychiatric Center, and numerous changes that will occur in light of the state’s settlement agreement with the federal Department of Justice must be taken into consideration. Many changes are occurring simultaneously and will continue to change over time.
MeadowWood Behavioral Health Services which is located in New Castle County is a free standing, for profit, psychiatric and substance abuse treatment facility. MeadowWood proposes to add 20 inpatient beds at its existing facility. This is a revised request; MeadowWood originally requested 30 additional beds, but during the review process scaled back its request. The information provided by the applicant indicates that the facility is running at 100% capacity currently, with about 145 patient diversions this year through June of 2011. The capital cost of almost $4.4 million for the expansion will be funded through Acadia, its parent company. The review committee finds that the applicant meets the review criteria.
Conclusion: Having considered the certificate of public review criteria, and in light of the unpredictable variables in behavior patterns over the next few years, the review committee recommends approval of the amended application for 20 beds on the condition that the applicant will provide the Board with a written plan for alternative flexible uses for the proposed space should circumstances change in the next few years and the beds are not needed. The applicant has submitted its plan to the committee and that plan has been shared with the board.
A motion was made by Mr. Love to approve the application from MeadowWood Behavioral Health to add 20 beds. The motion was seconded by Mr. Walsh. The motion carried.
Development
Presentation and Discussion – Sheila Grant
Ms. Grant presented research findings on health care spending, quality and outcomes, from the Dartmouth Institute for Health Policy & Clinical Practice, Center for Health Policy Research.
Some important highlights:
The Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States
This research has helped policymakers, the media, health care analysts and others improve their understanding of our health care system
The Atlas forms the foundation for many of the ongoing efforts to improve health and health systems across America.
Medicare spending in 2006 varied more than threefold across U.S.
Some of the variation is due todifferences in the prices paid for similar servicesand differences in illness
Even after accounting for these factors, twofold differences remain
The differences in spending are almost entirely made up of the differences in volume of health care servicesprovided to similar patients.”
In areas of high supply (of specialists, hospital beds, ICU beds, etc.), patients and providers reported long waits for services.
Patients in high cost areas get more expensive care and fewer low-cost preventive services
In a fee for service system, lots of smart health care providers are looking for ways to keep their beds and waiting rooms full
Access is WORSE when there are MORE medical resources.
More specialists involved means more opportunities for mistakes
Hospitals are dangerous places if you don’t need to be there
The big three automakers (Ford, GM, Dailmer/Crysler) have found a relationship between CON states and lower health care costs
Other Business
Health Policy Coordination: Dr. Rempusheskispoke about the importance of coordination between Delaware Health Care Commission(DHCC) and Delaware Health Resources Board (DHRB). The next meeting for DHCC is the first Thursday of January starting at 9 a.m., DelDOT Administration Building, Dover. Dr. Rempusheski has asked Ms. Riveros to give a presentation to the DHRB, examining health policy in Delaware and the intersection of various Boards. The goal is coordinated policy.
Sunset update: The DHRB has been scheduled for its hearing before the Joint Sunset Committee on February 22, 2012 at 5:30 pm, Joint Finance Committee hearing room, Legislative Hall, Dover.
Public Comment
No public comments.
Announcement of Next Meeting: January 26, 2012
Adjournment: The Board adjourned.
Attending Guests
Mr. Tom O’Keefe – Wohlsen Construction
Mr. Peter Rosen- Nanticoke Memorial Hospital
Mr. Steve Rose- Nanticoke Memorial Hospital
Mr. Don Tricarici- Nanticoke Memorial Hospital
Dr. S. Foster- MeadowWood Behavioral Health
Ms. Julie Saville- MeadowWood Behavioral Health
Mr. Gary Murphy- MeadowWood Behavioral Health
Mr. Stan Silver- MeadowWood Behavioral Health
Ms. Cheryl Heiks-Cozen O’Connor
Ms. Maria Valeregru- MeadowWood Behavioral Health
Mr. William Weaver – Dover Behavioral Health
Mr. John McKenna – Universal Health Services
Mr. Kumar Purohit - Rockford Center
Ms. Debbie Hamilton-Cozen O’Connor
Mr. Paul Lakeman- Bayhealth Medical Center
Mr. Hiran Ratnayake – Christiana Care
Mr. Bill Mason – MeadowWood Behavioral Health
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