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SHAUGHNESSY REHAB HOSPITAL - BOARD OF TRUSTEES MEETING MINUTES OF SPECIAL MEETING AUGUST, 1979 SPECIAL MEETING BOARD OF TRUSTEES August 13, 1979 On Monday evening, August 13 , 1979, at 5 : 00 p. m. a meeting was held in the Board Room of the hospital. Those present were: Doctors Shaughnessy and Woll, Miss Dumont, Messrs. Carnevale and Brophy; Attorney John O'Leary, Mr. Joseph Connolly; and from Blue Cross, Manager of Provider Contracts , Mr. Joseph Fermano and his assistant, Mr. Marty Atkins. Mr. Brophy explained that the purpose of the meeting was to discuss the meeting scheduled for August 16 with the Rate Setting Commission regarding the CR-1 contract. Reviewing the situation he stated that the Commission had failed to approve the contract on July 12, that they had in fact "tabled" the matter and that Mr. Greenwood had so notified Mr. Affanato on July 13 , following up with a letter dated July 20 to Mr. Affanato. Blue Cross plans . to resubmit the contract for approval. The letter from Mr. Greenwood enclosing a letter of support from Carroll Colby of the North Shore Health Planning Council was discussed, as well as a second letter dated July 26 from Mr. Greenwc wherein the following reasons were presented for the Commission' s tabling of the contract and the Blue Cross subsequent withdrawal of the contract : (1) The contract should wait until the hospital meets the conditions of participation, rather than using an addendum lengthening the qualifying period; (2) The belief that financial constraints due to penalties of the Medicaid reimbursement and the financial viability of the hospital could not sustain the level of rehabilitation required; and (3) The need for a consensus as to the demand for these types of services at this hospital. Mr. Brophy stated that he had received a letter setting up this meeting from Mr. Greenwood, for the purpose of considering support needed to obtain approval of the CR-1 contract, and also a letter from John A. Daly, Executive Secretary of Rate Setting allowing the hospital to be present at their meeting on August 16 to present oral comments to assist the Commission in its deliberations . Asked by Mr. Brophy for his evaluation of our present position, Mr. Fermano of Blue Cross indicated that he felt the letter from the local HSA is a very positive point and makes a very strong commit- ment. He stated that he felt the Commission would then discuss the addendum which waives the Criteria for Participation for a one year period (actually originally for six months) and we would then have to sell them on the fact that at the end of a one year period the hospital would be in conformity. The requirement that 2/3 of admissions must be acute rehabilitation and z of all dis- charges must be to either acute care or a lesser level of care was reviewed. Also, we will need strong statements from the hospital regarding its ability to meet the resource level of funds required to fulfill these stipulations . Minutes - Meeting of August 13, 1979 Page 2 Mr. O'Leary asked what the requirement for nursing hours per patient day was under the contract. Mr. Atkins replied that it was not stated but that hospitals such as New England Rehab and Braintree are up at around 6 to 7 hours per day. Miss Dumont stated that we are presented at a level of 3.5 to 4 hours per day. The report that Rate Setting hears that the hospital has "budget" problems every year with the taxpayers was discussed. Mr. O'Leary stated that they are apparently concerned about "short-fall", but that obviously the city had made a very large corm-itment. He noted that Blue Cross had indicated in their letter of July 26 their belief that the hospital cannot presently sustain the level of rehabilitation required because of the question of financial viability. Mr. O'Leary also suggested that possibly Blue Cross might consider the waiver with the one-year time limit to provide the hospital with time needed to do a marketing job. Taking all of these facts into consideration, Attorney O'Leary stated that he is considering the advisability of withdrawing the contract from consideration and waiting. Doctor Woll discussed the anticipated length of stay for rehab patients under the contract. Mr. Atkins reviewed their expectations, saying that a 30-day stay or less was usual. Doctor Woll commented that this was an unrealistic figure and cited the example of patients being discharged from these other rehab facilities at this point and then needing to come here at least on an out-patient basis to continue their treatment. Mr. Ferman queried, assuming that the Commission accepts the addendum, would the hospital be able to attract the proper patients. Doctor Woll replied that this could be difficult and that he has already instituted a program of going out to other hospitals with a presentation about the rehab department with members of his staff. Mr. O'Leary reiterated his feelings that it would take the hospital more than two days to properly prepare for the hearing with the Commission. In view of Mr. O'Leary's advice, Mr. Brophy expressed the opinion that he would like to be absolutely sure that when we do go in to discuss the contract, we will present the best case that we have, and that based on the merits of the case, we would either win, lose, or draw. Mr. Atkins informed those present that he felt we had a good chance in our scheduled hearing this week because of the fact that one of the Chairmen of the Commission, Peter Hiam, is on vacation. It was his feeling that the other two members of the commission could be swayed to vote in our behalf. Attorney O'Leary repeated that he would like to postpone, and suggested a time early in September to present our case to Rate Setting. Mr. Brophy agreed, stating that we should hold off until we can be properly armed with whatever information we feel is necessary, with the proper people, etc. Minutes - Meeting of August 13, 1979 Page 3 Thereafter, Mr. Fermano agreed that he would go to the Commission the next day, pull the contract and ask them to hold it until we are ready. Questioned about the Blue Cross patients we have already accepted, Mr. Atkins stated that Blue Cross would stand by the ccmmitment to cover them, as per Mr. Greenwood's agreement. Mr. Atkins offered to go in to the Commission the next day to get a reading as to probable results of a hearing. Mr. Connolly stated that he did not feel this was a good idea and that it was inconceivable that they would vote without the Head Cmutissioner. Mr. Atkins revised his propsal, suggesting that he would discuss with the Cctmdssion the possibility of a six-month waiver rather than a one-year waiver. Mr. Atkins agreed that he would contact Mr. Brophy to let him know how this works out. Mr. Brophy thanked Mr. Fermano and Mr. Atkins for their time in attending the meeting and they left, with the others still in attendance. Mr. Brophy asked Mr. O'Leary to send him a listing of the data required when we go before Rate Setting Ce mission in September. Mr. O'Leary replied that it would perhaps be easiest to take a few minutes at this meeting and to pull together this listing, so that we would be able to comnence working on it. Accordingly Mr. O'leary reviewed the requirements and evolved the listing which is attached hereto and marked as "APPENDIX A". Meeting adjourned at 5:05. Respectfully submitted, c Joanne McManus Executive Secretary APPENDIX A Meeting of 7/13/79 Blue Cross in response to Mr. Brophy's inquiry as to exactly what substantiation he would need for the CR-1 contract, Mr. O'Leary listed the following: 1. Document the case for meeting all of the Criteria of Eligibility listed on Page 8 of 63 of the contract. 2. Documentation regarding organized Medical Staff. 3. Substantiate the formal mechanisms on a team basis (minutes of all meetings, etc.) 4. Establish that the program is individualized. 5. Some idea of how things are going with respect to new admissions. (Check out definition of "Covered Rehab Care" on page 2, definition F and see if we are in compliance.) Suggest that we make a study of admissions for the past 6 months and the same 6-month period a year ago, comparing statistics on patient origin, average age, number of rehab candidates, where discharged, etc.) 6. Marketing - Would like. to. kncw from Dr. Wbll about how we are changing referral patterns of the doctors who refer patients. (document speaking before Medical Staffs of other hospitals) 7. Regarding financial viability of the hospital, Dr. Woll and Van should address the question of the extent of rehab and whether we need increased staffing to sustain the level of rehab as required by the contract. 8. Get copy of letter from Beverly Hospital about trnasfer of rehab patients. 9. Updated statement on need, from the following sources: Health Planning Council, individuals, groups who can be used as a consensus. (refer to original Certificate of Need) Also check report of staff to Public Health Council on DON regarding Beverly application. Find out if report of staff was accepted in total; otherwise refer to Health Counci. report.