SER­VICE

Dorchester Star - - Re­gional - News Kent County

Re­gional Health, dated March 24 and marked con­fi­den­tial, and four ap­pen­dices, which in­clude re­ports from the sys­tem’s var­i­ous ser­vice lines.

Some of those ser­vice lines — such as med­i­cal spe­cialty and sur­gi­cal spe­cialty — dis­cuss the fea­si­bil­ity of mov­ing in­pa­tient ser­vices to a new re­gional med­i­cal cen­ter, a fa­cil­ity Shore Re­gional Health has been look­ing to lo­cate in Eas­ton.

Ac­cord­ing to a mes­sage from the Ser­vice De­liv­ery Coun­cil chair­men Stu­art M. Bounds and Dr. Thomas Stauch that opens the draft plan, con­sid­er­a­tion to turn the Ch­ester­town and Cam­bridge hos­pi­tals into am­bu­la­tory care cen­ters that do not of­fer in­pa­tient beds was put on hold.

Patti Wil­lis, Shore Re­gional Health se­nior vice pres­i­dent of strat­egy and com­mu­ni­ca­tions, de­clined an in­ter­view re­quest from the

on the draft plan. In her email Fri­day, April 15, she said Shore Re­gional Health of­fi­cials are not pre­pared to dis­cuss the draft.

“The doc­u­ment, which is pro­pri­etary and con­fi­den­tial, has not been rec­om­mended by the strate­gic plan­ning com­mit­tee nor has it been viewed or ap­proved by the Shore Re­gional Health Board of Direc­tors. We ex­pect ro­bust dis­cus­sion at meet­ings of both groups dur­ing April and May,” Wil­lis wrote. The Ground­work Both Bounds and Stauch, an or­tho­pe­dic sur­geon, are Shore Re­gional Health board mem­bers. Their open­ing mes­sage in the draft ser­vice de­liv­ery plan states dis­cus­sions were tabled on turn­ing the Ch­ester­town and Cam­bridge hos­pi­tals into am­bu­la­tory care cen­ters be­cause of “two sig­nif­i­cant de­vel­op­ments” in the state.

This year, the Gen­eral As­sem­bly passed leg­is­la­tion to es­tab­lish a work group to study the fu­ture of health care in ru­ral parts of the state. That same bill also specif­i­cally states “a li­censed hos­pi­tal lo­cated in Kent County may not con­vert to a free­stand­ing med­i­cal fa­cil­ity ... be­fore July 1, 2020.”

Ac­cord­ing to the draft plan, Shore Re­gional Health board mem­bers, physi­cians, ex­ec­u­tives and man­agers pre­vi­ously spent five months re­view­ing trends and the im­pacts of de­clines in hos­pi­tal use rates, in­creases in out­pa­tient surgery and ef­forts to cut down on how long pa­tients are stay­ing in hos­pi­tals and the num­ber of in­pa­tient ad­mis­sions.

“In April 2015, the Work­group pre­sented a pos­si­ble frame­work for health care de­liv­ery on the Mid-Shore to the Board which out­lined an ar­ray of re­gional ser­vices from pri­mary care and di­ag­nos­tics fa­cil­i­ties, to spe­cialty med­i­cal pavil­ions, a free­stand­ing med­i­cal fa­cil­ity at Queen­stown, am­bu­la­tory hos­pi­tals in Ch­ester­town and Cam­bridge and a new Re­gional Med­i­cal Cen­ter in Eas­ton,” the draft states.

There is “ex­cess phys­i­cal ca­pac­ity” at Shore Re­gional Health fa­cil­i­ties, ac­cord­ing to the draft. Ch­ester­town’s hos­pi­tal re­port­edly has the low­est in­pa­tient room use, rang­ing from 40 to 67 per­cent, and the Cam­bridge hos­pi­tal’s op­er­at­ing room use ranges from 12 to 65 per­cent.

“How­ever, the Board be­lieved that fur­ther study was needed at a ser­vice line-spe­cific level and based upon the unique needs of pa­tients and providers across the re­gion be­fore it could take a po­si­tion on the pro­posed frame­work,” the draft states.

That led to the cre­ation of the Ser­vice De­liv­ery Coun­cil helmed by Bounds and Stauch. Ac­cord­ing to the coun­cil char­ter, the group was tasked with us­ing a va­ri­ety of data to map out how pa­tients would “nav­i­gate” all the ser­vices avail­able through Shore Re­gional Health.

“The Coun­cil will de­velop and rec­om­mend ser­vices es­sen­tial to sup­port high qual­ity, pa­tient fo­cused and cost ef­fec­tive care through­out the re­gional sys­tem,” the draft ser­vice plan states.

Five ser­vice line coun­cils were con­vened to share the work­load: on­col­ogy (can­cer), med­i­cal spe­cial­ties, sur­gi­cal spe­cial­ties, be­hav­ioral health and pri­mary care. A physi­cian and a Shore Re­gional Health ex­ec­u­tive re­port­edly were paired to lead each of the five sub­groups.

Ac­cord­ing to the draft, the sub­groups con­sid­ered five dif­fer­ent types of ser­vice fa­cil­i­ties and where those may best be lo­cated to serve the Mid-Shore’s var­i­ous com­mu­ni­ties. Those fa­cil­i­ties were pri­mary care of­fices, med­i­cal pavil­ions with mul­ti­ple ser­vice providers, free­stand­ing emer­gency de­part­ments, hos­pi­tals with emer­gency de­part­ments and ob­ser­va­tion units, but no in­pa­tient beds and full-ser­vice in­pa­tient hos­pi­tals.

“In the course of that dis­cus­sion and re­search, it be­came clear to the Shore and UMMS lead­er­ship that for ru­ral re­gions such as this one — with pock­ets of vul­ner­a­bil­ity that are unique in Mary­land, due to dis­tances, de­mo­graph­ics, eco­nom­ics and pop­u­la­tion health is­sues — there may need to be more re­sources to sup­port the needs of cit­i­zens than what the Mary­land reg­u­lated sys­tem now pro­vides for,” the draft states.

Dis­cus­sions re­port­edly com­menced with state law­mak­ers, re­sult­ing in the agree­ment to com­plete a study of ru­ral health care and to put a hold on any changes to “in­pa­tient med­i­cal sur­gi­cal bed ca­pac­ity” at Ch­ester­town’s hos­pi­tal. Like­wise, con­sid­er­a­tion about “po­ten­tial re­con­fig­u­ra­tions” of the Cam­bridge hos­pi­tal is not ad­dressed in the draft plan.

“Mean­while, it is clear that the cost of main­tain­ing the aged phys­i­cal plant of the hos­pi­tal in Eas­ton has reached a tip­ping point where a re­place­ment is nec­es­sary,” the draft states, adding that the five ser­vice lines sub­groups sup­port the idea of a new hos­pi­tal in Eas­ton of­fer­ing re­gional ser­vices. Com­mon Themes The draft ser­vice de­liv­ery plan lists the sub­group rec­om­men­da­tions county by county. The med­i­cal spe­cial­ties sub­group of­fered some of the most spe­cific sug­ges­tions, such as con­sid­er­ing out­pa­tient en­doscopy at Cam­bridge, re-open­ing the sleep cen­ter in Ch­ester­town and re­cruit­ing a neu­rol­o­gist with stroke in­ter­est at Eas­ton.

Most of the rec­om­men­da­tions listed by the other sub­groups were sim­i­lar for each county, if not iden­ti­cal in the draft plan. The be­hav­ioral health sub­group rec­om­men­da­tions, many of which fo­cused on cre­at­ing com­mu­nity part­ner­ships to bol­ster ser­vices, are nearly the same across all five coun­ties.

The draft out­lines a num­ber of com­mon themes found across Shore Re­gional Health’s ser­vice lines. At the top of the list is one of the many con­cerns raised by Kent County res­i­dents over the idea of ser­vices mov­ing to Eas­ton: trans­porta­tion.

“Clin­i­cal Coun­cils con­sis­tently iden­ti­fied pa­tient and fam­ily trans­porta­tion (par­tic­u­larly trans­fer ser­vices from com­mu­nity or am­bu­la­tory hos­pi­tals to a re­gional spe­cialty cen­ter) as a sig­nif­i­cant is­sue with the Re­gional Med­i­cal Cen­ter Model, con­sid­er­ing the low pop­u­la­tion over a large area, ag­ing of the pop­u­la­tion, and so­cioe­co­nomic fac­tors in cer­tain ar­eas,” the draft states.

One op­tion of­fered in the draft is to find a part­ner to es­tab­lish a re­gional med­i­cal trans­porta­tion ser­vice be­yond the Mid-Shore’s lim­ited public trans­porta­tion sys­tem.

Then there are the physi­cian short­ages and the need to bol­ster re­cruit­ment strate­gies. The draft iden­ti­fies this as one of the most sig­nif­i­cant is­sues.

“Loan for­give­ness, tu­ition re­im­burse­ment and other re­cruit­ment strate­gies must be de­vel­oped, ex­panded and funded to sup­port crit­i­cal physi­cian and provider needs, par­tic­u­larly in ru­ral ar­eas, and leg­isla­tive ini­tia­tives should be de­vel­oped to sup­port such strate­gies,” the draft states.

Telemedicine — think physi­cian con­sul­ta­tions via In­ter­net ser­vices like Skype — is cited as an­other op­por­tu­nity for Shore Re­gional Health to in­crease spe­cial­ized ser­vices such as psy­chi­a­try in less pop­u­lated ar­eas. Ac­cord­ing to the draft, this could al­low for spe­cial­ists at Univer­sity of Mary­land Med­i­cal Cen­ter to as­sist pa­tients on the Mid - Shore with­out leav­ing the Bal­ti­more hos­pi­tal.

The draft speaks to the ben­e­fits of mov­ing to ex­tended ob­ser­va­tion stays at med­i­cal fa­cil­i­ties in­stead of in­pa­tient ad­mis­sions, while not­ing that there are con­cerns about mak­ing such a change.

“The abil­ity to re­gion­al­ize spe­cialty and in­pa­tient ser­vices, and to achieve re­duc­tions in po­ten­tially avoid­able in­pa­tient use and read­mis­sions, will de­pend in large part on hav­ing ac­cess to a clin­i­cal de­ci­sion unit with ex­tended ob­ser­va­tion beds of up to 72 hours, ac­cord­ing to the clin­i­cal ser­vice line sub-coun­cils,” the draft states.

The sub­groups also made rec­om­men­da­tions about im­prov­ing elec­tronic health record ca­pa­bil­i­ties and the es­tab­lish­ment of a call cen­ter to help pa­tients with chronic dis­ease bet­ter co­or­di­nate their care, the draft states.

The sub­groups re­port­edly en­dorsed “ro­bust and tar­geted” outreach, ed­u­ca­tion and screen­ing pro­grams to aid in the “best man­age­ment of pop­u­la­tion health and the cre­ation of health­ier com­mu­ni­ties.”

“These pro­grams pro­vide ex­cel­lent op­por­tu­ni­ties for part­ner­ships with other or­ga­ni­za­tions, from health de­part­ments and dis­ease ad­vo­cacy groups to se­nior cen­ters, com­mu­nity groups and busi­nesses,” the draft states.

A Re­gional Cen­ter

Dis­cus­sions about plans for Shore Re­gional Health’s three hos­pi­tals — Shore Med­i­cal Cen­ter at Ch­ester­town, Shore Med­i­cal Cen­ter at Dorch­ester (Cam­bridge) and Shore Med­i­cal Cen­ter at Eas­ton — are spelled out more di­rectly in the draft ser­vice de­liv­ery plan’s sec­ond ap­pen­dix. It con­tains the one-page ser­vice line re­ports filed by each of the five sub­groups.

The be­hav­ioral health, on­col­ogy, med­i­cal spe­cialty and sur­gi­cal spe­cialty sub­groups all speak to the fea­si­bil­ity of re­lo­cat­ing ser­vices to a re­gional med­i­cal cen­ter.

“The Pri­mary Care Com­mit­tee prefers lo­cal­ized ac­cess to in­pa­tient ser­vices and thus rec­om­mended that Shore Health main­tain in­pa­tient ser­vices at SMC-Ch­ester­town and SMC-Dorch­ester. How­ever, the com­mit­tee de­fers to the Med­i­cal Spe­cialty and Sur­gi­cal Spe­cialty Clin­i­cal Coun­cils as to the fea­si­bil­ity of cen­tral­ized in­pa­tient care pro­vided at a Re­gional Med­i­cal Cen­ter,” the pri­mary care re­port states.

The pri­mary care group cited trans­porta­tion avail­abil­ity and travel times to Eas­ton, as well as a po­ten­tial mar­ket share loss to non-UMMS hos­pi­tals, such as Anne Arun­del Med­i­cal Cen­ter in An­napo­lis and Penin­sula Re­gional Med­i­cal Cen­ter in Sal­is­bury, as con­cerns.

“The On­col­ogy Com­mit­tee out­lined a com­pre­hen­sive can­cer care model that is cen­tral­ized at the Re­gional Med­i­cal Cen­ter, in­cludes satel­lite cen­ters at Ch­ester­town, Cam­bridge, and Queen­stown, and uti­lizes UMMS fa­cil­i­ties for spe­cial­ized ser­vices not avail­able at the Re­gional Med­i­cal Cen­ter,” the on­col­ogy re­port states.

The need to ad­dress trans­porta­tion is­sues and physi­cian re­cruit­ment was shared by var­i­ous sub­groups. The med­i­cal spe­cialty and sur­gi­cal spe­cialty sub­groups also called for ob­ser­va­tion ca­pa­bil­i­ties to be main­tained at the Ch­ester­town and Cam­bridge hos­pi­tals. Sub­ject to Change The draft ser­vice de­liv­ery plan is by no means fi­nal­ized. What it cur­rently of­fers is a look at con­ver­sa­tions held by top-rank­ing ex­ec­u­tives and physi­cians in the Mid-Shore’s health sys­tem.

While it con­firms there is talk about get­ting rid of in­pa­tient beds in Ch­ester­town and Cam­bridge, the draft also raises con­cerns about is­sues such a move will leave for pa­tients and how best to ad­dress them.

Shore Re­gional Health has been con­duct­ing lis­ten­ing ses­sions through­out the Mid - Shore in an ef­fort to ob­tain public in­put on ser­vices. The fi­nal ses­sion is sched­uled for 2 p.m. Sun­day, April 24 in the Sudlersville fire­house at 203 N. Church St.

In her April 15 email, Wil­lis said Shore Re­gional Health’s Strate­gic Plan­ning Com­mit­tee will not ad­dress the draft plan “un­til the fi­nan­cial im­pact of its many rec­om­men­da­tions can be over­laid on the full doc­u­ment and un­til the com­mu­nity feed­back from this month’s lis­ten­ing ses­sions can be in­cor­po­rated into the rec­om­men­da­tions.”

“The plan­ning process that has brought us to this point has been thor­ough, in­clu­sive of all in­ter­ests and points of view and has fol­lowed the out­line with which we be­gan last year,” Wil­lis wrote.

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