TULARE REGIONAL
MEDICAL CENTER
Reva Evero
Jasmine Junnarkar
Meyda Lengkong
April 20, 2012
OUTLINE
Background on Organization
Summary of Recommendations
Overview of Current TRMC Strategy
Action Plans For Recommendations
Impact of Healthcare Reform
Conclusion
BACKGROUND ON TRMC
Tulare Regional Medical Center
(TRMC) is facing challenges that
include:
1. Competitive Pressure
2. Physician Staffing
3. Financial Strains
SUMMARY OF RECOMMENDATIONS
1. Expansion of current partnerships with
academic medical centers
2. A pilot project to convert a clinic into
Federally Qualified Health Center
(FQHC) through an alliance with the
public health department
3. Value based Quality Improvement (QI)
Program
OVERVIEW OF CURRENT TMRC
STRATEGY: IMAGE RENOVATION
Investing in state-of-the-art
buildings and equipment to attract
new physicians and patients
Partnering with other health care
organizations
Expanding presence in rural areas
Focusing on community wellness
RECOMMENDATION 1: PHYSICIAN
STAFFING
 Action Plan:




Expanding linkage between University
of Southern California (USC) and TRMC
Regain market share in select
specialties through partnerships with
USC
Establish rural focused residency
programs
Revitalize image of TMRC as a leader
in health care throughout the Central
Valley
RECOMMENDATION 1: PHYSICIAN
STAFFING
 Specialists
 Draw: New Facility, Latest in Medical Technology
 Investing in Relationships with colleagues, leading
physicians
 Demand for Services
 Primary Care Physician (PCP)
 Loan forgiveness
 Conversion to FQHC
 Demand for Services
 Patients
 Better Quality of Care
 More Access to Care
RECOMMENDATION 2: FQHC
CONVERSION
Public Trust
Community
support for
the
conversion of
FQHC
Community
Needs
Assessment
Partnership
of TRMC with
Tulare County
public health
department
Enhance
hospital
reputation
Local
recognition
for improving
health status
of community
RECOMMENDATION 2: FQHC
CONVERSION
TRMC
•Conversion of
Rural Health
Clinic (RHC) to
Federally
Qualified Health
Center (FQHC)
•Promotion of
Evolution
Fitness and
Wellness Center
Tulare
County
Public
Health
Department
RECOMMENDATION 2: FQHC
CONVERSION
Facility
TRMC Rural Health Clinic (RHC)
Federally Qualified Health
Center (FQHC)
Federal Grants
No
Yes, up to $650,000 for new
starts
Medical
malpractice
coverage
No
Yes
Medicare
Payment Rates
$78.54*
Rural: $109.90*
Urban: $ 126.98*
Loan repayment
and waiver of
work visa for
foreign MDs
No
Yes
Benefits:
•Adapted from Medicare Payment Advisory Commission (MedPAC), Report to Congress: Medicare and the Health Care Delivery System (2011)
www.medpac.gov/chapters/Jun11_Ch06.pdf
*Cited from Centers for Medicare & Medicaid Services (CMS), Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Centers
(FQHC) Payment Rate Increases (2012) www.ngsmedicare.com/
RECOMMENDATION 2: FQHC
CONVERSION
Requirements of FQHC
Current TRMC
RHC
Private non-profit or public organization
✔
Serving medically underserved areas
✔
Comprehensive primary health care services
✔
Minimum service hours of 32 hours per week
✔
Professional call coverage during closing hours
✔
Maintain a core staff to provide necessary services
✔
Majority of board members are users of center
✖
•Adapted from Medicare Payment Advisory Commission (MedPAC), Report to Congress: Medicare and the Health Care Delivery System (2011)
www.medpac.gov/chapters/Jun11_Ch06.pdf
RECOMMENDATION 2: FQHC
CONVERSION
Education of Federally Qualified Health Center
(FQHC) to leadership in TRMC
Formation of FQHC steering committee and
appointment of board members
November Implementation of FQHC pilot program in one
2012 RHC
November Evaluation of pilot project and house wide
2013 expansion of project
May 2012
August
2012
RECOMMENDATION 2: FQHC
CONVERSION
•Adapted from Office of Statewide Health Planning and Development (OSHPD), 2010 Tulare Regional Medical Center Annual Financial
Disclosure Report http://siera.oshpd.ca.gov/annualfinancial.aspx
RECOMMENDATION 3:
QI PROGRAM
Action Plan:
Develop an organization wide Quality
Improvement (QI) program in
anticipation of Medicare Hospital
Value-based Purchasing
RECOMMENDATION 3:
QI PROGRAM
FY 2011 Medicare
Patient Revenue
Medicare
Traditional
Medicare
Managed
Total
Net Inpatient Revenue
$12,823,051
$1,597,507
$14,420,558
FY 2013
FY 2014
FY 2015
FY2016
FY 2017
Percent
Reduction
1% 1.25% 1.5% 1.75% 2%
Potential
Loss
$144,206 $180,257 $216,308 $252,360 $288,411
Total
$1,081,542
•Adapted from Office of Statewide Health Planning and Development (OSHPD), 2011 Tulare Regional Medical
Center Annual Financial Disclosure Report http://siera.oshpd.ca.gov/annualfinancial.aspx
RECOMMENDATION 3:
QI PROGRAM
System wide change thru:
Defining quality metrics based on Center for
Medicare and Medicaid Service (CMS) measures
Facilitate physician and staff involvement
Utilization of new health information system
Holding departments accountable
Monthly review of quality performance
Quarterly review of financial metrics
Incentivize meeting performance targets
RECOMMENDATION 3:
QI PROGRAM
Culture of
shared
responsibility
Dynamic
learning
Hospital wide
involvement
Open
communication
Motivation to
improvement
System
Wide
Quality
Improvement
Commitment to
meeting
performance
targets
RECOMMENDATION 3:
QI PROGRAM
Establishes TRMC as a leader in
quality within the community
1. Increases physician and staff
alignment
2. Improves coordination of patient
care
3. Improves hospital efficiency
4. Reduces waste and associated costs
IMPACT OF HEALTHCARE REFORM
Uncertainties
Principles
• Quality
Healthcare
Reform
• Value
• Vertical
Integration
Recommendations
1) Expansion of
partnership with
Academic
Medical Center
2) Alliance with
Tulare County
Public Health
for FQHC
conversion
3) Quality
Improvement
program using
HIS
Outcomes
Increased
quality
Increased
value
Increased
vertical
integration
CONCLUSION
PHYSICIANS
TRMC
FQHC
Quality
Improvement
Quality
Customer Service
Compliance/Ethics
Finance/Efficiency
People
Growth
Community