Ru­ral health work­group dis­cusses care op­tions

Record Observer - - News - By DO­RIAN MITCHELL dmitchell@thekent­coun­tynews.com

CHESTERTOWN — En­sur­ing pa­tients re­ceive the best care tai­lored to their spe­cific needs while keep­ing over­all costs at a min­i­mum was the theme of the Mary­land Health Care Com­mis­sion’s Ru­ral Health Care De­liv­ery Plan Work­group meet­ing Mon­day, Jan. 9.

Held in Wash­ing­ton Col­lege’s Hyn­son Lounge, this was the work­group’s third meet­ing. The group is re­spon­si­ble for de­vel­op­ing a plan to meet the health care needs of the five Mid-Shore coun­ties.

The panel in­cluded health care rep­re­sen­ta­tives, elected of­fi­cials and busi­ness own­ers from dif­fer­ent coun­ties. The ses­sion was led by work­group co-chairs Deborah Mizeur, owner of Apoth­e­o­sis Herbs in Chestertown, and Dr. Joseph Ciotola of the Queen Anne’s County health and emer­gency ser­vices de­part­ments.

Health Ser­vices Cost Re­view Com­mis­sion Prin­ci­pal Deputy Di­rec­tor Katie Wun­der­lich pro­vided an up­date on the on­go­ing Mary­land All-Payer Model project. It was formed through a part­ner­ship be­tween the State of Mary­land and the Cen­ters for Medi­care & Med­i­caid.

The rate set­ting sys­tem model is de­signed to be statewide, en­com­pass­ing the to­tal cost of care for a hos­pi­tal and not just in­pa­tient and out­pa­tient ser­vices.

“We want to make sure that our health care de­liv­ery is not just in one set­ting, but cap­tures a con­tin­uum of places where pa­tients ex­pe­ri­ence care,” Wun­der­lich said.

She said this model would be ef­fec­tive for ru­ral hos­pi­tals, which can ex­pe­ri­ence “de­clin­ing mar­gins” and lesser de­mands for in­pa­tient ser­vices.

Howard Haft, deputy sec­re­tary for pub­lic health at the De­part­ment of Health and Men­tal Hy­giene, talked about a pri­mary care model cen­tered around “pa­tient cen­ters.”

He said th­ese cen­ters, over­seen by a care trans­for­ma­tion or­ga­ni­za­tion, would be lo­cated in a com­mu­nity rather than a hos­pi­tal. They would have both physi­cians and spe­cial­ists, from nu­tri­tion­al­ists to care man­agers, work­ing as a team to help pa­tients.

Haft said pri­mary care physi­cians, es­pe­cially those in a ru­ral set­ting, would ben­e­fit from the con­cept. He said they would be able to treat each pa­tient thor­oughly and “get off their tread­mills” of rush­ing to see as many peo­ple as they can.

“It’s hard to re­cruit pri­mary care doc­tors to a ru­ral area. The pay is not great, the work is hard and you’re iso­lated,” he said. “This is one of the an­ti­dotes for that.”

Haft said the pri­mary care model would align all in­ter­ests, from large to small hos­pi­tals, and pro­mote co­op­er­a­tion within health sys­tems. He said the model is ex­pected to launch next year and ties in with the Al­lPayer Model.

A dis­cus­sion, led by Health Man­age­ment As­so­ciates Prin­ci­pal Jack Meyer, re­volved around the pri­mary care model. Gar­rett County Me­mo­rial Hos­pi­tal was a fo­cus, due to its im­ple­men­ta­tion of the Well Pa­tient pro­gram in­side the hos­pi­tal.

Pres­i­dent and CEO Mark Boucot said though it is “not cheap,” the pro­gram has helped im­prove over­all sta­tis­tics across the board.

He said it al­lows a cadre of hos­pi­tal em­ploy­ees and com­mu­nity health work­ers to not only tend to a pa­tient with health man­age­ment prob­lems, but also pro­vide a sup­port struc­ture that al­lows the pa­tient to be­come self-suf­fi­cient.

“We’re shift­ing re­sources from be­ing com­pletely hos­pi­tal-based to a more com­mu­nity fo­cus,” Boucot said. “It’s a lit­tle bit dif­fer­ent and I feel pretty proud.”

Most of those at the work­shop spoke in fa­vor of the pri­mary care model. Mar­garet Malaro of Centreville Fam­ily Medicine said this model would help her to not feel “like she is on a ger­bil wheel ev­ery day.”

“I feel that the essence of this model is ‘What you would do if it was your fam­ily mem­ber who came in?’” she said.

How­ever, there were con­cerns. Mary­land State Med­i­cal So­ci­ety Pres­i­dent and CEO Gene Ran­som, for­mer Queen Anne’s County com­mis­sioner, said he was wor­ried that the cre­ation of new pro­grams would only put more pres­sure on hos­pi­tals.

He also raised points about about the as­so­ci­ated costs that come with a pri­mary care model, es­pe­cially for ru­ral pa­tients.

Other par­tic­i­pants called the model’s lead­er­ship

PHOTO BY DO­RIAN MITCHELL

Mary­land Ru­ral Health Care De­liv­ery Plan Work­group co-chair­man Deborah Mizeur and Joseph Ciotola lead a dis­cus­sion on how to best serve pa­tients in the five Mid-Shore coun­ties Mon­day, dur­ing a meet­ing at Wash­ing­ton Col­lege in Chestertown.

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