Minnie Hamilton Health Care Center (MHHCC) is an 18-bed, not-for-profit Critical Access Hospital (CAH), providing acute care, emergency medicine, rehabilitation therapies, imaging and related outpatient ancillary services to the residents Grantsville, West Virginia and surrounding communities. In addition, MHHCC operates a rural health clinic (RHC) in Grantsville and an FQHC in Glenville, WV along with various community programs including dental services, and 24-bed long-term-care facility. MHHCC is one of two Federally Qualified Health Centers (FQHC) in the United States that operate a CAH. Their mission is to provide personalized, high-quality care on an as-needed or preventative basis. They proudly state, “We have created a practice that we believe in and choose for our own family members.” Carla Brock Wilber, Senior Consultant, with Stroudwater Associates, worked with MHHCC in 2017, through the Small Rural Hospital Transition (SRHT) project, on a Quality of Care and Transition of Care Project. Center staff spoke with Stephen Whited, CEO; Sandra Ellis, Director of QI, Risk and Patient Safety; and Brittany Frymier, Administrative Assistant, just six months after the implementation of the consultant recommendations to discuss their progress.
Q: What are some of the recommendations that you’ve implemented in these first six months and what are your next steps?
A: Regarding the Emergency Department (ED), MHHCC closely tracked time on “Decision to admit to time of ED departure.” They educated ED providers concerning details of the measure and they provide the data monthly to providers and nursing staff so they can see each individual patient times and provider and nurse information. This has decreased from pre-project measure of 122 minutes to a recently low of 57 minutes. Currently they are at 74 minutes, very close to the goal of 70.
Previously, daily huddles to discuss discharge planning were held three days a week and they now conduct them five days a week and strongly encourage providers to participate. In preparation for this change, administration shared ideas with their providers about with this topic. Participation is tied to incentives. The huddles also include representatives from pharmacy, physical therapy and other disciplines relevant to individual cases. Recently the discharge planner implemented LACE tool. This is a new strategy for MHHCC and they are closely evaluating patients for risk for readmit in 30 days. This has been very important since it’s been difficult to identify readmissions to other facilities. Internally, their readmission rates are very good (0 for 12 months) but they are most interested in preventing external readmissions. Another strategy to reduce readmissions has been to enhance their swing bed program. They developed brochures for this program and communicate this service to patients before they are transferred from the ED. They plan to increase marketing to other hospitals for referral back to MHHCC and track transfers so that the discharge planner can follow up with the receiving hospital to discuss a referral back.
MHHCC believes their biggest accomplishment on the SRHT project is the improved education of providers and staff on data. The board quality committee is very involved and HCAHPS training is conducted for all supervisors. Each supervisor receives a monthly dashboard of current data to post in their departments.
Q: What has been the impact of this project so far on MHHCC?
A: The measurable outcomes will be reported in six months. Non-measurable impact has already been clear and includes:
• Improved information and data sharing with supervisors and then driving information down to staff
• The addition of quality as a topic to staff meeting agendas
• More transparency as they create a culture of quality and safety
• A desire to continue to improve even though they are doing well in comparison to peers
Q: Lastly, how do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
A: “Things are working; we are getting there. Ready to have conversations about raising the bar without settling. All the documentation and quality impacts reimbursement and we have a better understanding of this now. Understanding better how to meet patient needs and prevent readmission while impacting wellness.”
Your input is needed for the Downtown Charleston Elders/Artists Housing Poll
The Charleston Urban Renewal Authority has joined with an ad hoc group to explore the possibility of creating new housing for seniors and artists in the downtown area of Charleston. We have developed a survey to gauge the interest in such a project as well as get a sense of how area residents envision future housing for themselves. We are using a “snowball” method of distributing the survey which means we need your help in getting it out.
We ask that you take this online survey by going to this web address: https://www.surveymonkey.com/r/HCP3RPY (be sure to click the last green box to get your answers recorded!)
Then put this notice, or one you write yourself, with the above web address on your social media and/or message that you send to friends, family and colleagues on your e-mail lists. The more it ‘snowballs’, the bigger our sample and the more reliable our findings. The survey takes about 10 minutes. Hope you have fun filling it out and thank you for participating.
Senior Legislation Watch
Notes from WVPEL Director, Phil Schenk
In his State of the State address, Governor Jim Justice used the word “senior” once. That was a reference to the grade level of one of the basketball players on the team that he coaches. Given that West Virginia is, by percentage, one of the top 3 states in the Union for over-65 populations, this omission is noteworthy. The legislature, however, is looking at a number of bills directly related to elders.
The bills noted below are some of those introduced so far that relate to elder living. It is not presented as a complete list, but is a representation. Note that most of these bills relate to lowering the tax burden on seniors either by altering the existing homestead exemption reduction on property taxes or by reducing income taxes – especially on Social Security income. Numbers 2 and 9 provide other benefits to elders.
- SB 97 a fixed-income credit for low income senior citizens; establishing procedures for claiming credit; and defining terms. The bill calls for a 1% credit for those with incomes up to 125% of the federal poverty level (FPL) and then reducing that credit by 4% of the amount for each percentage point of income over 125% (SB125 also includes this provision or a similar one)
- HB2044 relating to the Senior Farmers’ Market Nutrition Program; creating the Senior Farmers’ Market Nutrition Program Fund; and requesting additional funds to be added to the fund. This would raise the amount of vouchers for seniors at farmers’ markets from $20 to $50.
- SB139 -relating to changing the qualifier for low income from 150% or less to 300% or less of the FPL for a senior citizens’ homestead tax credit. This would help seniors with incomes from about $18,000 (single person or about $24,360 for a family of 2) up to about $36,000 (single person or about $48,700 for a family of 2) on their property taxes.
- HJR 15 – constitutional amendment to lock in the values of a home at the assessed value of the home when homeowner turned 65.
- HB2358 taking Social Security benefits out of the calculation of adjusted gross income (AGI) for state income taxes (not federal) on a sliding scale. For example: those with incomes of $0-$50,000 would not include any Social Security income in their AGI. Those with incomes of between $50,000 and $70,000 would take 80% of their Social Security income off the AGI. The bill has further cuts depending on income in its sliding scale.
- HB2217 relating to increasing the maximum personal income tax exemption for persons over the age of sixty-five and for persons who are totally disabled.
- HB2323 exempting SS benefits from state income tax altogether.
- HB2848 – relating to providing a tax credit for the costs of modifying homes to make them more accessible for an elderly person or a person with a disability.
- SB87 – relating to allowing a person to purchase a Class XS resident senior hunting, fishing and trapping license at the beginning of the year he or she becomes 65, if otherwise eligible.
We strongly urge readers to stay in touch with the AARP West Virginia news regarding legislative actions at the Capitol that relate to seniors in our state.
Dr. Amy Parker Sayre and Kathy Gillenwater Hill, NP will be joining Dr. Chad Adkins in the new BMH Family Medical Center (former BMH Admin/ER), with an anticipated opening of January 2018. Their clinic will be located on the 2nd floor (former BMH Administration Suite) and the Rapid Care Clinic will move from State Street to the 1st floor (former BMH ER). Dr. Adkins, Dr. Sayre and Kathy Hill, NP are now accepting new patients.
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Pharmacy giant CVS Health has agreed to buy Aetna in a $69 billion blockbuster acquisition that could rein in health-care costs and transform its 9,700 pharmacy storefronts into community medical hubs for primary care and basic procedures, the companies announced Sunday afternoon.
The pharmacy chain agreed to buy Aetna for about $207 per share, broken down into $145 in cash and the rest in stock. The deal — the biggest health-care merger announced in more than a year — is expected to close in the second half of 2018, subject to approval by shareholders and regulators.
If approved, the megamerger would create a giant consumer health-care company with a familiar presence in thousands of communities. Aetna chief executive Mark T. Bertolini described the vision in an interview as “creating a new front door for health care in America.”
The tax reform framework released by the Trump administration and Congressional Republican leaders on September 27 would affect states differently, but every state would see its richest residents grow richer if it is enacted, according to this new report from the Institute on Taxation and Economic Policy.
One in six taxpayers would see a tax increase under this regressive tax shift.
Nationally, more than two-thirds (67 percent) of the tax cuts contained in the framework would go to the richest one percent of Americans in 2018. The middle fifth of households, people who are literally the “middle-class,” are projected to earn between $41,000 and $66,000 in 2018. These households would receive an average tax cut of just $410 next year, which would increase their incomes by an average of just 0.8 percent.
This West Virginia Center on Budget and Policy blog looks at how the GOP tax framework will impact West Virginians. In the Mountain State, the richest one percent of residents would receive 39.1 percent of the tax cuts within the state under the framework in 2018, according to Institute on Taxation and Economic Policy. These households, with incomes of at least $358,800, would receive an average tax cut of $27,800 in 2018. The framework is especially beneficially to those earning more than $1 million. These households represents 0.1 percent of the state’s population but would receive 22 percent of the tax cuts if the plan was in effect next year.
In contrast, West Virginia’s middle-class would receive just 7.3 percent of the tax cuts that go to West Virginia under the framework. In 2018 this group is projected to earn between $33,500 and $52,700. The framework would cut their taxes by an average of just $260.