Holy Cross Health Meeting the Needs of the Senior Population

Judith Rogers, RNC, MSN, PhD

President, Holy Cross Hospital

February, 2016

Service Area Holy Cross Hospital’s service area includes about 1.7 million residents of Montgomery and Prince George’s counties

Montgomery

County

Prince George’s

County

Washington D.C.

*

Key Statistics HOLY CROSS HEALTH

Overview

Founded in 1963

516 licensed beds (423 HCH; 93 HCGH), including 46 NICU bassinets and 8 Special Care Nursery Bassinets

1,947 member medical staff

Revenue of $472 million*

Services

34,931 discharges, 197,615 outpatient registrations, and 38,253 health center visits*

103,719 emergency visits*

• * FY15 actuals. Health center visits at four health centers and two clinics (AMV; KIM)

2

We are leaders in a number of clinical programs Women and Infants

Highest volume of deliveries in Maryland and Washington, DC

Highest NICU volume in the state and outstanding outcomes for very low birthweight infants

Seniors

First seniors Emergency Center in the nation

2nd leading provider of stroke care in Montgomery County for all ages and 3rd for seniors

Surgery

Highest volume for gynecology (including gynecological oncology) in Maryland and Washington, DC

Highest volume of inpatient surgery in Montgomery County

First hospital to offer robotic surgery in the County

3

We have sustained our long-standing commitment to community benefit

23.4

45.6

0 10 20 30 40 50

Average of 4 other

hospitals in

county

Holy Cross Health

Total Community Benefit Millions of Dollars

Five Year Average (FY10-14)

Range = $9.7-$38.6

4

In 2000, seniors were heavily concentrated in southern Montgomery County

5

By 2030, the upcounty seniors population will grow significantly, particularly in the Gaithersburg-Germantown area

6

839 887773 779

127

127

254

90182

648

920

200

400

600

800

1,000

1,200

2010 Growth 2030 2010 Growth 2030

0-64 65+

We have been looking ahead In our area, the 65+ population (shown in yellow) will dominate growth during the next 20 years

Montgomery County

Prince George’s County

Population in Thousands

0.3%

3.5%

0%

3.6%

By 2020, 15% of our service area will be >65

As the population ages, the percent of discharges and days for people age 65+ (shown in yellow) will increase significantly

Montgomery County Population, Discharges and Inpatient Days by Age, 2010-2030

13%18%

22%

42%

50%

57%

50%

58%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2020 2030 2010 2020 2030 2010 2020 2030

Population Dicharges Days

65+

<65

8

People age > 65 use inpatient days 6x as much as <65. By 2030, there will be a need for 276 more med/surg inpatient beds on Montgomery County.

In this context, the seniors emergency center met a clinical and demographic need

• Developed with the help of the Erickson School of Aging, University of

Maryland Baltimore Campus

• Extensive collaboration across the hospital including senior leadership

and physicians in creating the vision and planning the service

• Focus on change management

– Allocation of appropriate resources to be successful

– Data review to monitor patient satisfaction and clinical outcomes • Features

– 8 private rooms

– Care processes modified (risk assessment, follow up)

– Environment modified (non-reflective floor, special mattresses)

– Geriatric trained staff (dedicated geriatric social worker and nurse

practitioner; nursing staff received geriatric education)

– Links to community-based services, which will be even more important in

the future

9

HCH Seniors ED Purpose

• Focus on improving

– Patient care

– Patient experience

– Staff engagement and satisfaction

– Health care resource allocation

– Readmission rates

– Complication rates

– LOS

– Payment denials/reimbursement risks

10

HCH Seniors ED Goals

• Focus on

– Optimizing utilization of both in and outpatient resources

– Establishing effective and expedient outpatient resource access and care transitions

– Preparing for the fact that acute care episodes are often accompanied by:

• Functional decline

• Increased dependency

• Increased morbidity

11

Patient and Family

• Focus on

– Respect and dignity

– Information sharing

– Engagement

– Collaborative decision making

– Partnership/allies

– Participation as part of the team

– Sustainability of support systems

12

We had lots of media coverage, but the NPR story was key

National Public Radio

Catholic Health World

Local radio/local newspaper

Erickson Tribune

AARP (magazine, online radio)

Washington Post article appeared

Announcement press release followed immediately

Facilitated future Washington Post article

(photos; staff and patient interviews) Nov/Dec

2008

Jan 2009

February

March

April/May

American Medical Association news

Emergency Nurses Association on line

ABC Channel 7

2010 CBS Radio Canada

AARP Magazine

13

We also had two very successful integrated marketing campaigns (including radio) “Just in Case” Medical Information Card • Wallet card for personalized emergency

information • 4,700 requests for 7,500 kits

“Surgery for Seniors: What to Ask, What to Know” • Kit outlines special considerations for

seniors prior to surgery; materials can be personalized

• 1,300 requests

14

We presented at several key national association meetings and were covered in a variety of national publications

Presentations • Catholic Health Association

Assembly

• American Association of Home

Services for Aging

• National Council on Aging

• American Case Management

Association

• National NICHE conference

• National Geriatric Nurses

Association

Publications • Health Progress article

• Nursing Executive Watch

• Advance for Nurses Magazine

• ED Management

Magazine/Newsletter

• Joint Commission Environment

of Care Newsletter

• The Journal of Gerontological

Nursing

• Annals of Emergency Medicine

15

The seniors emergency center was the breakthrough that served as a catalyst for advancing care of seniors to a new level

• NICHE participation (Nurses Improving Care for Healthsystem Elders)

– Geriatric sensitivity training and resource nurses

• Seniors ambulatory surgery center

– Appeal to patients who appreciate the added safety of a hospital setting

– Improved pre-surgical processes

– Attention to clinical issues specific to geriatric patients

• intra-operative positioning, anesthesia, pain management, post-operative needs

• extra time to recover

– Dedicated area within PACU/ASD

16

Holy Cross Health has been a leader in caring for seniors with innovative programs and services since 1982

• Beginning in CY2008, Holy Cross Health began expanding its clinical senior service line

• 2008-2009 – Opened the nation’s first seniors ED and ambulatory surgery center

• 2011 – Implemented an Acute Care for the Elderly Program for medicine unit

• 2015 – Established a geriatric primary care practice within a CCRC

• Future endeavors – Nexus Montgomery regional partnership, geriatric assessment and palliative care consultation center

1963 Holy Cross Hospital

1982 Medical Adult Day Center

1985 Wellness Classes

1992 Caregiver Resource Center

1993 Faith Community Nurse

Program 1995 Senior Fit

1997 Senior Source

2008 Nation’s First Seniors

Emergency Center

2008 NICHE Designation

2009 Nation’s First Seniors

Ambulatory Center

2011 ACE Program on Medicine Unit

2014 Holy Cross Germantown

Hospital

2015 Holy Cross Health Partners at

AMV

2015 Nexus Montgomery

Regional Partnership

17

Holy Cross Health offers a broad array of senior services

18

Holy Cross Hospital has been and continues to be a market leader in providing care to seniors

19

Seniors Service Line

Seniors are an important service line for Holy Cross Health –19% of all visits and 33% of revenue are attributed to adults 65+

81%

19%

<65 65+

67%

33%

<65 65+

20

Holy Cross Health continues to increase share in the HCH service area primarily due to growing volumes at HCGH; HCGH share was at 2.8% in Q1 FY16 while HCH share has decreased slightly from 18.9% in FY15 to 17.9% in Q1 FY16

HCH Service Area: HCH & HCGH Seniors Inpatient Market Share

Note: This report reflects the most recent time period for market share data, FY16, quarter 2 is expected to be available in late February. Source: Patient Care Analyst

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FYTD16

HCH HCGH HC Hlth

Maintaining market leadership in seniors care requires offering a full spectrum of senior services to address the needs of this population

• Seniors 65+ self-report poor health and health behaviors in pockets of our service area –predominately in Prince George’s County

• While there are fewer seniors in Montgomery County and Prince George’s County with 6+ chronic conditions than Maryland or the U.S., spending on these seniors is higher

• There is currently a shortage of geriatricians, both nationally and in our service area, to meet seniors’ needs

• Holy Cross Health is uniquely positioned to address many of these issues by continuing its comprehensive seniors program

21

We became known for seniors “Attribute association” results of our 2010/2012 consumer survey compared to 2008 are stunning

* Statistically above the 2008 result (p<.05)

22

We wanted to build a reputation for seniors as we have for maternal child services – and we did!

* 2010 data; Statistically greater than any other hospital (p<.05)

23 percent said we had the best services for seniors (higher than for women’s services); the next highest percentage was 6 percent

23

Attribute Holy Cross Hospital Comp-etitor 1

Comp-etitor 2

Comp-etitor 3

Comp-etitor 4

Comp-etitor 5

Comp-etitor 6

Comp-etitor 7

Don’t Know/ None

The hospital trusted most to provide the best quality care for you and your family

20* 8 3 8 3 5 5 5 12

Has the best reputation for meeting the health care needs of women

19* 4 2 7 5 1 5 3 37

Has the best services for seniors

23* 6 3 3 2 3 3 3 40

• Demographics won’t lie

• Seniors have choice and the ability to exercise it

• We need to change the way we deliver care to this most important demographic group

• Success will enhance mission attainment and simply make you better at providing clinical services to the elderly and to all

Concluding Remarks

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Questions

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