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.