Holy Cross Health Meeting the Needs of the Senior Population Judith Rogers, RNC, MSN, PhD President, Holy Cross Hospital February, 2016
Service Area Holy Cross Hospital s service area includes about 1.7 million residents of Montgomery and Prince George s counties Montgomery County Prince George s County Washington D.C. *
Key Statistics HOLY CROSS HEALTH Overview Founded in 1963 516 licensed beds (423 HCH; 93 HCGH), including 46 NICU bassinets and 8 Special Care Nursery Bassinets 1,947 member medical staff Revenue of $472 million* Services 34,931 discharges, 197,615 outpatient registrations, and 38,253 health center visits* 103,719 emergency visits* * FY15 actuals. Health center visits at four health centers and two clinics (AMV; KIM) 2
We are leaders in a number of clinical programs Women and Infants Highest volume of deliveries in Maryland and Washington, DC Highest NICU volume in the state and outstanding outcomes for very low birthweight infants Seniors First seniors Emergency Center in the nation 2 nd leading provider of stroke care in Montgomery County for all ages and 3 rd for seniors Surgery Highest volume for gynecology (including gynecological oncology) in Maryland and Washington, DC Highest volume of inpatient surgery in Montgomery County First hospital to offer robotic surgery in the County 3
We have sustained our long-standing commitment to community benefit Total Community Benefit Millions of Dollars Five Year Average (FY10-14) Holy Cross Health 45.6 Average of 4 other hospitals in county Range = $9.7-$38.6 23.4 0 10 20 30 40 50 4
In 2000, seniors were heavily concentrated in southern Montgomery County 5
By 2030, the upcounty seniors population will grow significantly, particularly in the Gaithersburg-Germantown area 6
We have been looking ahead In our area, the 65+ population (shown in yellow) will dominate growth during the next 20 years Population in Thousands 1,200 1,000 800 600 400 200 0 127 3.5% 0.3% 839 887 127 48 254 0-64 65+ 90 By 2020, 15% of our service area will be >65 3.6% 0% 182 773 779 2010 Growth 2030 2010 Growth 2030 92 6 Montgomery County Prince George s County
As the population ages, the percent of discharges and days for people age 65+ (shown in yellow) will increase significantly Montgomery County Population, Discharges and Inpatient Days by Age, 2010-2030 100% 90% 13% 18% 22% 80% 70% 42% 50% 57% 50% 58% 65% 60% 50% 65+ <65 40% 30% 20% 10% 0% 2010 2020 2030 2010 2020 2030 2010 2020 2030 Population Dicharges Days People age > 65 use inpatient days 6x as much as <65. By 2030, there will be a need for 276 more med/surg inpatient beds on Montgomery County. 8
In this context, the seniors emergency center met a clinical and demographic need Developed with the help of the Erickson School of Aging, University of Maryland Baltimore Campus Extensive collaboration across the hospital including senior leadership and physicians in creating the vision and planning the service Focus on change management Allocation of appropriate resources to be successful Data review to monitor patient satisfaction and clinical outcomes Features 8 private rooms Care processes modified (risk assessment, follow up) Environment modified (non-reflective floor, special mattresses) Geriatric trained staff (dedicated geriatric social worker and nurse practitioner; nursing staff received geriatric education) Links to community-based services, which will be even more important in the future 9
HCH Seniors ED Purpose Focus on improving Patient care Patient experience Staff engagement and satisfaction Health care resource allocation Readmission rates Complication rates LOS Payment denials/reimbursement risks 10
HCH Seniors ED Goals Focus on Optimizing utilization of both in and outpatient resources Establishing effective and expedient outpatient resource access and care transitions Preparing for the fact that acute care episodes are often accompanied by: Functional decline Increased dependency Increased morbidity 11
Patient and Family Focus on Respect and dignity Information sharing Engagement Collaborative decision making Partnership/allies Participation as part of the team Sustainability of support systems 12
We had lots of media coverage, but the NPR story was key Nov/Dec 2008 Facilitated future Washington Post article (photos; staff and patient interviews) Jan 2009 February Washington Post article appeared Announcement press release followed immediately National Public Radio Catholic Health World Local radio/local newspaper Erickson Tribune AARP (magazine, online radio) March American Medical Association news April/May 2010 Emergency Nurses Association on line ABC Channel 7 CBS Radio Canada AARP Magazine 13
We also had two very successful integrated marketing campaigns (including radio) Just in Case Medical Information Card Wallet card for personalized emergency information 4,700 requests for 7,500 kits Surgery for Seniors: What to Ask, What to Know Kit outlines special considerations for seniors prior to surgery; materials can be personalized 1,300 requests 14
We presented at several key national association meetings and were covered in a variety of national publications Presentations Catholic Health Association Assembly American Association of Home Services for Aging National Council on Aging American Case Management Association National NICHE conference National Geriatric Nurses Association Publications Health Progress article Nursing Executive Watch Advance for Nurses Magazine ED Management Magazine/Newsletter Joint Commission Environment of Care Newsletter The Journal of Gerontological Nursing Annals of Emergency Medicine 15
The seniors emergency center was the breakthrough that served as a catalyst for advancing care of seniors to a new level NICHE participation (Nurses Improving Care for Healthsystem Elders) Geriatric sensitivity training and resource nurses Seniors ambulatory surgery center Appeal to patients who appreciate the added safety of a hospital setting Improved pre-surgical processes Attention to clinical issues specific to geriatric patients intra-operative positioning, anesthesia, pain management, post-operative needs extra time to recover Dedicated area within PACU/ASD 16
Holy Cross Health has been a leader in caring for seniors with innovative programs and services since 1982 Beginning in CY2008, Holy Cross Health began expanding its clinical senior service line 1963 Holy Cross Hospital 1982 Medical Adult Day Center 1985 Wellness Classes 2008-2009 Opened the nation s first seniors ED and ambulatory surgery center 1992 Caregiver Resource Center 1993 Faith Community Nurse Program 1995 Senior Fit 2011 Implemented an Acute Care for the Elderly Program for medicine unit 1997 Senior Source 2008 Nation s First Seniors Emergency Center 2008 NICHE Designation 2015 Established a geriatric primary care practice within a CCRC Future endeavors Nexus Montgomery regional partnership, geriatric assessment and palliative care consultation center 2009 Nation s First Seniors Ambulatory Center 2015 Holy Cross Health Partners at AMV 2011 ACE Program on Medicine Unit 2015 Nexus Montgomery Regional Partnership 2014 Holy Cross Germantown Hospital 17
Holy Cross Health offers a broad array of senior services 18
Holy Cross Hospital has been and continues to be a market leader in providing care to seniors Seniors Service Line Seniors are an important service line for Holy Cross Health 19% of all visits and 33% of revenue are attributed to adults 65+ 19% 81% 33% 67% <65 65+ <65 65+ 19
HCH Service Area: HCH & HCGH Seniors Inpatient Market Share Holy Cross Health continues to increase share in the HCH service area primarily due to growing volumes at HCGH; HCGH share was at 2.8% in Q1 FY16 while HCH share has decreased slightly from 18.9% in FY15 to 17.9% in Q1 FY16 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% FY09 FY10 FY11 FY12 FY13 FY14 FY15 FYTD16 HCH HCGH HC Hlth Note: This report reflects the most recent time period for market share data, FY16, quarter 2 is expected to be available in late February. Source: Patient Care Analyst 20
Maintaining market leadership in seniors care requires offering a full spectrum of senior services to address the needs of this population Seniors 65+ self-report poor health and health behaviors in pockets of our service area predominately in Prince George s County While there are fewer seniors in Montgomery County and Prince George s County with 6+ chronic conditions than Maryland or the U.S., spending on these seniors is higher There is currently a shortage of geriatricians, both nationally and in our service area, to meet seniors needs Holy Cross Health is uniquely positioned to address many of these issues by continuing its comprehensive seniors program 21
We became known for seniors Attribute association results of our 2010/2012 consumer survey compared to 2008 are stunning * Statistically above the 2008 result (p<.05) 22
23 percent said we had the best services for seniors (higher than for women s services); the next highest percentage was 6 percent Attribute Holy Cross Hospital Competitor 1 Competitor 2 Competitor 3 Competitor 4 Competitor 5 Competitor 6 Competitor 7 Don t Know/ None The hospital trusted most to provide the best quality care for you and your family Has the best reputation for meeting the health care needs of women 20* 8 3 8 3 5 5 5 12 19* 4 2 7 5 1 5 3 37 Has the best services for seniors 23* 6 3 3 2 3 3 3 40 We wanted to build a reputation for seniors as we have for maternal child services and we did! * 2010 data; Statistically greater than any other hospital (p<.05) 23
Concluding Remarks Demographics won t lie Seniors have choice and the ability to exercise it We need to change the way we deliver care to this most important demographic group Success will enhance mission attainment and simply make you better at providing clinical services to the elderly and to all 24
Questions 25