CCHN - Conference Presenters

The Chautauqua Conference: Exellence in Health Care Delivery

Evaluation
Of
Excellence in Health Care Delivery Conference

Prepared by:
Constance L. Kramer, Consultant

Amethyst Consulting
748 Stilson Rd, Hunt, NY
Tel: 585-476-2273
E-mail: connkr923@frontiernet.net

July 18, 2003

Post-Conference Links and Information

Table Discussion Report

Table Discussions

THE PROCESS

THE MEDICAID CRISIS
POLITICS AND HEALTH REFORM
PREVENTION: THE KEY TO SUCCESS (Table 1)
PREVENTION: THE KEY TO SUCCESS (Table 2)
NATIONAL REFORM
COMPARATIVE HEALTH SYSTEMS
PROVIDER ISSUES: (HOSPITAL AND PHYSICIAN CHALLENGES)
RURAL CHALLENGES
COMMUNITY INITIATIVES

PROCESS FOR DISCUSSION TABLES

BEGIN WITH:

Facilitator introduction
Timeline and process reviewed
Recorder and Reporter Appointed and Introduced
The table discussion topic announced
Following process below starting with:
- Participant introductions
  - Name, Affiliation, Role
  - Business case and/or Personal reasons for joining table?
  - Reaction to a topical question?

PROCESS:

Discussion identifying issues/concerns
Recorder notes participants' points on flip chart
Group organizes issues using labels A - Z
Prioritize organized issues:
- Each participant individually on paper chooses 3 of A - Z as their individual priority and assigns a weight from 1 - 3, where 3 is the greatest and each weight is used once.
- The recorder notes each participant's rating for A - Z on the provided rating worksheet and calculates the total for each. Next to items A - Z on the flip chart mark the group's total value.
- Assign Priority 1 to the category with the greatest total. Designate the remaining 2 Priorities in the same manner.
On new chart sheet, state the three priorities in descending order.
Reports given by appointed reporter.

TABLE TOPIC: THE MEDICAID CRISIS
	ISSUES/CONCERNS CATERGORIZED A. Cost: Tax Burden -(local Real property) Low reimbursements Hospital, Doctors, Dentists Scope of benefits LTC- End of life care Risk & outcome based care reimbursement NYS buys with Medicaid Dollars Limited Dollars, can't spend more Chronic care costs B. Quality: More procedures-lower proficiency UR not Standard Quality base reimbursement provider vs. facility Non-compliant patients Preventative care C. Bureaucracy: Cost Shifting- Inmate/Medicaid eligibility Definition/ enforcement Fraud Compliance Conflicting directives Dollar chasing Provider disincentive
	PRIORITIZATION OF CATEGORIES Seven participants rated three categories.
PRIORITIES: THE MEDICAID CRISIS
Priority	Description	Value
1	Bureaucracy: Cost Shifting Inmate/Medicaid eligibility Definition/ enforcement Fraud Compliance Conflicting directives Dollar chasing Provider disincentive	15
2	Cost: Tax Burden (local Real property) Scope of benefits Low reimbursements Hospital, Doctors, Dentists LTC- End of life care Chronic care costs NYS buys with Medicaid Dollars Risk & outcome based care reimbursement Limited Dollars, can’t spend more	14
3	Quality: More procedures-lower proficiency UR not Standard Quality base reimbursement provider vs. facility Non-compliant patients Preventative care	13

TABLE TOPIC: POLITICS AND HEALTH REFORM
	ISSUES/CONCERNS CATERGORIZED A. Subject complexity: How do we educate elected officials? Politicians not leading by their actions B. How do we identify actual costs of Health Care and Certify this information? Cost Accounting in Heath Care are overlooked No definition of cost: Action: Define/redefine the cost of giving Care Action: After redefining cost consider control extents @ $4000 C. Curb or minimize the influence of lobbyist /self interest Follow Pattern of defense industry D. Target Population: Under 65 Uninsured E. How do we get reform through the legislative process? Get a foot in the door F. Redefine the end of Life Policies and Expenses Action: Advance Directives G. Is Health Care a fundamental right? This should be determined by government H. Elected officials and the industry should be totally truthful regarding all aspects of health care.
	PRIORITIZATION OF CATEGORIES Five participants rated eight categories.
PRIORITIES: POLITICS AND HEALTH REFORM
Priority	Description	Value
1	Cost Accounting in Health Care is over looked Action: Define/redefine the individual costs of giving care	14
2	Health Care is a complex subject: How do we educate elected officials?	7
3	Government/ elected Officials and the health Care industry should be totally truthful regarding all aspects of health care.	3

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESS Table 1 of 2
	ISSUES/CONCERNS CATERGORIZED A. Who will pay for it (Education of Consumers) B. No incentive to talk about prevention C. No time for Nurses to educate D. No Follow-ups E. Consumers not interested (need incentive to become educated and incorporate life style changes.) F. Prevention programs geared toward personal buy-in Consumers need to have incentive to become educated and incorporate life style changes G. Need mechanisms to teach prevention: Need to include Community Employers Schools Parents DSS Hospitals Doctors Public Health H. Payer Source for Preventative Services I. Shift with-in the System and who does what J. Incentive for Insurance Company to prevent high Cost Cases K. One payment System
	PRIORITIZATION OF CATEGORIES Five participants rated ten categories.
PRIORITIES: PREVENTION: THE KEY TO SUCCESS (Table 1)
Priority	Description	Value
1	Prevention programs geared toward personal buy-in Consumers need to have incentive to become educated and incorporate life style changes	8
2	No incentive to talk about prevention	5
3	No time for Nurses to educate	5

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESS Table 2 of 2
	ISSUES/CONCERNS CATERGORIZED A. Identify and Meet Provider Needs: Incentives Hook/ Motivation Education Resources ie: Written Referral System B. Motivation and Education for Public Find Hook Change public mind set from Sick Care to Preventive Care C. Insurance and Money issues for both Public and Providers Disincentive for preventative care from Medicaid Medicare has no billing code from Maintenance / prevention
	PRIORITIZATION OF CATEGORIES Seven participants rated three categories.
PRIORITIES: PREVENTION: THE KEY TO SUCCESS (Table 2)
Priority	Description	Value
1	Motivation and Education for Public Find Hook Change public mind set from Sick Care to Preventive Care	20
2	Identify and Meet Provider Needs: Incentives Hook/ Motivation Education Resources i.e.: Written Referral System	14
3	Insurance and Money issues for both Public and Providers Disincentive for preventative care from Medicaid Medicare has no billing code from Maintenance / prevention	8

TABLE TOPIC: NATIONAL REFORM
	ISSUES/CONCERNS CATERGORIZED A. Public Dialogue about Health Care as a human right Public education about our system vs. rest of the world B. Expand Medicare Eligibility from 65 to 50 C. Better incorporate Social problems into the Health Care System D. Incentivize Healthy behavior/ lifestyle E. Should Medicaid/ Medicare be combined?
	PRIORITIZATION OF CATEGORIES Eight participants rated five categories.
PRIORITIES: NATIONAL REFORM
Priority	Description	Value
1	Public Dialogue about Health Care as a human right Public education about our system vs. rest of the world	23
2	Expand Medicare Eligibility from 65 to 50	13
3	Better incorporate Social problems into the Health Care System	6

TABLE TOPIC: COMPARATIVE HEALTH SYSTEMS
	ISSUES/CONCERNS CATERGORIZED A. Basic Universal Coverage- National Defense Health Act B. Subsidize Med. School ed. C. National standards/ Coordinated delivery D. Standards fees E. Free choice of providers F. Investment in psycho./ social issues
	PRIORITIZATION OF CATEGORIES Five participants rated six categories.
PRIORITIES: COMPARATIVE HEALTH SYSTEMS
Priority	Description	Value
1	National Defense Health Act- Provides basic universal health coverage	15
2	Investment in psycho/ Social issues	6
3	National Standards- Coordinated delivery affordable	5

TABLE TOPIC: PROVIDER ISSUES (HOSPITAL AND PHYSICIAN CHALLENGES)
	ISSUES/CONCERNS CATERGORIZED A. Reimbursement rates- Low for physicians- causing access issues for patients Cost- Unreimbursed Costs for Providers increasing costs for providing care. Ex: Ref. process (1 employee to focus on this) billing B. Reimbursement rates- Low for Hospitals, especially community Hospitals, causing access issues for patients Medicare: 60 % Medicaid: 15% HMO's: 15% C. Profiling/ Rating-Providers Accuracy Methodologyquestionable, reliable? Need for Robust Clinical Data D. Leadership for Quality Health Care Where is it going to come from? Physicians Employers Current legal/ regulatory/ liability concerns are prohibiting this Possible decrease in private practice and certain specialties E. Access to care for UN/ UNDERINSURED Can physicians afford it? F. Access to Staff (MD, RN, etc.) More Costly for nursing staff Recruitment retention Adverse events/ Medical errors Need for quality Staffers
	PRIORITIZATION OF CATEGORIES Five participants rated six categories.
PRIORITIES: PROVIDER ISSUES (HOSPITAL AND PHYSICIAN CHALLENGES)
Priority	Description	Value
1	Reimbursement Rates: Low for physicians, causing access issues for patients Low for hospital	12
2	Quality HealthCare Leadership in quality Current legal/ regulatory/ liability concerns Possible decrease in small private practice and certain specialties	7
3	Unreimbursed Costs for Providers Increasing overall cost for providing care Ex: Referral process, credentialing	6

TABLE TOPIC: RURAL CHALLENGES
	ISSUES/CONCERNS CATERGORIZED A. Recruiting Med./Dentist Lack of Professionals-Economic Issues Qualified People B. Reimbursement Issues Uninsured/ Underserved Hospital/Provider C. Basic Needs Lack of Transportation Child Care D. Social Issues/ Economic Education Culture Housing Services Ed./ Forums In Communities E. Disconnected Provider Level F. Mental Health Parody Child/ Psychiatric G. Quality
	PRIORITIZATION OF CATEGORIES Eight participants rated six categories.
PRIORITIES: RURAL CHALLENGES
Priority	Description	Value
1	Reimbursement Issues: 17 Hospital/ Providers	17
2 & 3	Recruitment Retention of Health/Medical/Dental Professionals Social/Economic Culture/Educational Provide Services in Communities Educate Forums (A and D above combined)	11

TABLE TOPIC: COMMUNITY INITIATIVES
	ISSUES/CONCERNS CATERGORIZED A. Promote and Provide Systemic Community Education B. Clarify the messages and Situations C. Community-Wide Systemic integration and implementation of resources, messages, action D. Identify community collaborators and supporters E. Identify and build on successful Health Care models and practices
	PRIORITIZATION OF CATEGORIES Five participants rated five categories.
PRIORITIES: COMMUNITY INITIATIVES
Priority	Description	Value
1	Clarify the messages and situations	10
2	Promote and provide Systemic Community Education	7
3	Community-Wide Systemic integration and implementation of resources, messages, action	7

TABLE TOPIC: BUSINESS/PROVIDER RELATIONSHIPS
No Interest - no discussion

TABLE TOPIC: MEDICARE FOR THE FUTURE
No Interest - no discussion

All documentation and audio from the Table Discussions are available on the
CD Production of the Conference

Post-Conference Links and Information

Chautauqua County Health Network

Evaluation Of Excellence in Health Care Delivery Conference

Prepared by: Constance L. Kramer, Consultant Amethyst Consulting 748 Stilson Rd, Hunt, NY Tel: 585-476-2273 E-mail: connkr923@frontiernet.net July 18, 2003

Post-Conference Links and Information

Table Discussion Report

Table Discussions

PROCESS FOR DISCUSSION TABLES

TABLE TOPIC: THE MEDICAID CRISIS

ISSUES/CONCERNS CATERGORIZED

A. Cost:

B. Quality:

C. Bureaucracy:

Bureaucracy:

Cost:

Quality:

TABLE TOPIC: POLITICS AND HEALTH REFORM

ISSUES/CONCERNS CATERGORIZED

A. Subject complexity: How do we educate elected officials?

B. How do we identify actual costs of Health Care and Certify this information?

C. Curb or minimize the influence of lobbyist /self interest

D. Target Population:

E. How do we get reform through the legislative process?

F. Redefine the end of Life Policies and Expenses

G. Is Health Care a fundamental right?

H. Elected officials and the industry should be totally truthful regarding all aspects of health care.

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESSTable 1 of 2

ISSUES/CONCERNS CATERGORIZED

A. Who will pay for it (Education of Consumers)

B. No incentive to talk about prevention

C. No time for Nurses to educate

D. No Follow-ups

E. Consumers not interested (need incentive to become educated and incorporate life style changes.)

F. Prevention programs geared toward personal buy-in

G. Need mechanisms to teach prevention: Need to include Community

H. Payer Source for Preventative Services

I. Shift with-in the System and who does what

J. Incentive for Insurance Company to prevent high Cost Cases

K. One payment System

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESSTable 2 of 2

ISSUES/CONCERNS CATERGORIZED

A. Identify and Meet Provider Needs:

B. Motivation and Education for Public

C. Insurance and Money issues for both Public and Providers

TABLE TOPIC: NATIONAL REFORM

ISSUES/CONCERNS CATERGORIZED

A. Public Dialogue about Health Care as a human right

B. Expand Medicare Eligibility from 65 to 50

C. Better incorporate Social problems into the Health Care System

D. Incentivize Healthy behavior/ lifestyle

E. Should Medicaid/ Medicare be combined?

TABLE TOPIC: COMPARATIVE HEALTH SYSTEMS

ISSUES/CONCERNS CATERGORIZED

A. Basic Universal Coverage- National Defense Health Act

B. Subsidize Med. School ed.

C. National standards/ Coordinated delivery

D. Standards fees

E. Free choice of providers

F. Investment in psycho./ social issues

TABLE TOPIC: PROVIDER ISSUES(HOSPITAL AND PHYSICIAN CHALLENGES)

ISSUES/CONCERNS CATERGORIZED

A. Reimbursement rates- Low for physicians- causing access issues for patients

B. Reimbursement rates- Low for Hospitals, especially community Hospitals, causing access issues for patients

C. Profiling/ Rating-Providers

D. Leadership for Quality Health Care

E. Access to care for UN/ UNDERINSURED

F. Access to Staff (MD, RN, etc.)

TABLE TOPIC: RURAL CHALLENGES

ISSUES/CONCERNS CATERGORIZED

A. Recruiting Med./Dentist

B. Reimbursement Issues

C. Basic Needs

D. Social Issues/ Economic

E. Disconnected Provider Level

F. Mental Health Parody

G. Quality

TABLE TOPIC: COMMUNITY INITIATIVES

ISSUES/CONCERNS CATERGORIZED

A. Promote and Provide Systemic Community Education

B. Clarify the messages and Situations

C. Community-Wide Systemic integration and implementation of resources, messages, action

D. Identify community collaborators and supporters

Evaluation
Of
Excellence in Health Care Delivery Conference

Prepared by:
Constance L. Kramer, Consultant

Amethyst Consulting
748 Stilson Rd, Hunt, NY
Tel: 585-476-2273
E-mail: connkr923@frontiernet.net

July 18, 2003

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESS
Table 1 of 2

TABLE TOPIC: PREVENTION: THE KEY TO SUCCESS
Table 2 of 2

TABLE TOPIC: PROVIDER ISSUES
(HOSPITAL AND PHYSICIAN CHALLENGES)

TABLE TOPIC: BUSINESS/PROVIDER RELATIONSHIPS
No Interest - no discussion

TABLE TOPIC: MEDICARE FOR THE FUTURE
No Interest - no discussion

All documentation and audio from the Table Discussions are available on the
CD Production of the Conference