Transcript North_Shore
The North Shore-LIJ Center for Comprehensive Care at
Greenwich Village A New Hybrid Model of Care to Deliver 21
st
Century Medicine
April 2011
Copyright 2010, All rights reserved
North Shore-LIJ Center for Comprehensive Care
I.
St. Vincent’s Catholic Medical Center II. Community Health Needs Assessment Study III. North Shore-LIJ Center for Comprehensive Care • • • • • Free-standing Emergency Department Imaging Center Ambulatory Surgery Center Laboratory Services Un-programmed physician and program space IV. Facilities • Building challenges • Conceptual Design 2
St. Vincent’s Catholic Medical Center – Timeline
St. Vincent’s merges with CMC Brooklyn/Queens SVCMC Network formed SVCMC Network files for Bankruptcy St. Joseph’s Hospital closed St. Mary’s Hospital closed and Sisters of Charity of Staten Island St. Vincent’s CMC files for Bankruptcy (4/6) St. Vincent’s Med Ctr closed (4/30
)
Bayley Seton transferred to Sisters of Charity SVCMC emerges from Bankruptcy Transfers St. John’s Queens and Mary Immaculate Hospital to Caritas Health System Community Needs Assessment Kick-off 1849 1980 1999 2000 2003 2005 2007 2009 2010 St. Vincent’s founded by the Sisters of Charity St. Vincent’s takes control of St. Vincent’s Staten Island St. Clare’s closed Acquires St. Clare’s Hospital Caritas files for Bankruptcy St. John’s closed - Mary Immaculate closed Transfers St. Vincent’s SI to Bayonne Medical Center HEAL 16 awarded to NS-LIJ UCC planned with VillageCare NS-LIJ acquires SVCMC Homecare
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Post SVCMC Closure Activities
April 2010
St. Vincent’s Closes
May 2010
Lenox Hill Joins North Shore-LIJ Health System
June 2010
HEAL Award to develop Urgent Care Center in Greenwich Village
August 2010
North Shore-LIJ partners with community leaders and elected officials to conduct Community Health Needs Assessment Study
January 2011
North Shore-LIJ receives CON approval for Urgent Care Center
March 2011
Urgent Care Center opens SVCMC accepts North Shore-LIJ proposal for Center for Comprehensive Care 4
Community Health Needs Assessment
• • • • •
Steering Committee Activities
Discussion Paper #1
–
Define Service Area
(10/1/2010)
Discussion Paper #2
– –
St. Vincent’s CMC Medical Center
The Origin of its Patients (10/27/2010) – A Review of Communities Receiving Care
Discussion Paper #3
– Socio-demographic Description of the Service Area (12/3/2010) – Overview of Health Status Indicators
Discussion Paper #4
– –
Post Closure Review
Service Area Access to and Utilization of Inpatient and Emergency Services (2/3/2011)
Discussion Paper #5
–
Projecting the Need for Inpatient Beds (In Draft)
• • •
To be completed Discussion Paper #6 - Results of Community Health Survey Discussion Paper # 7 - Identification of Service Area Health Needs and Service Gaps Discussion Paper # 8 – Recommendations for Community Health
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SVCMC Inpatient Discharges – Patient Origin
2009 SVCMC Inpatient Discharges
Patient Origin 1 dot represents 1 discharge 7
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• • • • •
North Shore-LIJ Center for Comprehensive Care
A new hybrid model combing the emergency department access of a community hospital with the specialized ambulatory services of a Diagnostic and treatment Center.
A destination facility licensed as a division of Lenox Hill Hospital Located in the former O’Toole Pavilion of SVCMC (162,000 bgsf) Anchor Programs will include:
– – –
New York’s first freestanding emergency center – 20,000 gsf
•
24 Treatment bays; 320 -Slice CT; X-Ray Imaging – 12,000 gsf
•
CT, MRI, Ultrasound, Angiography Ambulatory Surgery – 14,000 gsf
•
2 ORs
– –
Un-programmed space of 43,000 gsf pending completion of Community Health Assessment Beds for clinical decision making, patient stabilization and treatment
Center for Comprehensive Care wills serve as a new front door :
–
Integrate North Shore-LIJ health services into the fabric of the community;
–
Coordinate with existing providers and;
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Triage patients to the most appropriate facility/providers
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A New Hybrid Model of Care to Serve as the Front Door for Community Residents to Access Health Services
Physicians Mental Health Home Care Long Term Care ACCESS to SERVICES North Shore-LIJ Center for Comprehensive Care Front Door to Healthcare Hospitals Senior Care Substance Abuse Social Services Community Organizations Schools
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North Shore LIJ’s Vision for a Connected Community
To support clinical integration across the care continuum by sharing of clinical data to support safe, effective and efficient practice and an enhanced experience for patients by
:
Connecting patients and physicians in the community to support delivery of cutting-edge care
Coordination of care across practitioners, communication among practitioners, and seamless transitions in care between environments Management of entire “episodes of care” across practitioners and environments supported by proven care guidelines
Improvements in the quality of care delivery and facilitate participation in quality initiatives Home Care RHIOs Pharmacies Community Physicians NSLIJ CCC Patients & Families Hospitals Other Health Providers NS-LIJ CCC Labs Radiology
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Service Area
• • • • Defined by the Community Population of 385,000 residents – 13.2% age 65 and over 2.2% population growth next 5 years Payor Mix – 39.7% Medicare – 29.7% Medicaid – 22.8% Commercial – 7.8% Self-Pay
Legend
Primary Service Area (PSA) Secondary Service Area-I (SSA-I) Secondary Service Area-II (SSA-II) Former SVCMC site Community Board border 14
SVCMC and Service Area Inpatient Discharges, 2009
• • Service Area residents accounted for 41,000 Inpatient Discharges – 17% went to SVCMC Service Area accounted for 35% of SVCMC Inpatient Discharges – 50% of SVCMC Inpatient Discharges came from outside Manhattan
SVCMC Inpatient Discharges (N = 19,388) Other NYS 910 (4.7%) All other 1,338 (6.9%) Staten Island 384 (2.0%) Bronx 1,149 (5.9%) Queens 2,177 (11.2%) Manhattan 9,634 (49.7%) Brooklyn 3,796 (19.6%)
Source: SPARCS ver06.10.10jpl
Service Area 6,824 (35.2%) Other Manhattan 2,810 (14.5%) Bellevue 4,561 (11.1%) Inpatient Market Share (N = 40,915) NY Downtown 3,739 (9.1%) NYU 2,540 (6.2%) SVCMC 6,824 (16.7%) All other 11,577 (28.3%) Beth Israel 11,674 (28.5%)
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SVCMC and Service Area Treat & Release ED Visits, 2009
• • • • Service Area residents accounted for 100,000 Emergency Visits 87,172 were Treat and Release Visits – 38% Medicaid – 24% Self-Pay Almost 20,000 occurred at SVCMC Another 28,400 Treat and Release visits seen at SVCMC were from outside the Service Area
SVCMC T&R ED Visits (N = 47,822) Service Area T&R ED Visits (N = 87,172) Bellevue 14,158 (16.2%) NY Downtown 10,757 (12.3%) NYU 4,460 (5.1%) Other NYS 1,693 (3.5%) All other 4,391 (9.2%) Staten Island 615 (1.3%) Bronx 3,084 (6.4%) Queens 3,972 (8.3%) Manhattan 26,226 (54.8%) Brooklyn 7,841 (16.4%)
Source: SPARCS ver06.10.10jpl
Service Area 19,410 (40.6%) Other Manhattan 6,816 (14.3%) SVCMC 19,410 (22.3%) All other 14,996 (17.2%) Beth Israel 23,391 (26.8%)
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Service Area ED Visits, 2009 – NYU Algorithm
2009 Service Area ED Visits (Treat & Release) (n = 87,172) 9,507 10.9% 19,837 22.8% 2009 Service Area ED Visits (Treat & Release) of SVCMC (n = 19,410) 1,916 9.9% 3,472 17.9% 16,722 19.2% 3.6% 3,175 5,247 6.0% 9.5% 8,286 6.9% 6,034 21.1% 18,364
Sources: NYU Algorithm; NYS DOH SPARCS ver01.03.11
5,281 27.2% 18.4% 3,576 652
Non-Emergent Emergent/PCP Preventable Emergent/PCP Treatable Emergent Drug Alcohol Psychiatric Injury Other
8.9% 1,737 8.4% 1,637 5.9% 1,139
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Free-Standing Emergency Departments
• • • • • • • • • • FSED have existed for almost 40 years As of 2008 there were 222 operating in 16 states 191 of these are satellites /divisions of hospitals Traditionally, developed in response to access in rural areas, growing suburban, overcrowding and where a hospital has closed Open 24 /7 – 365 Days Most accept all patients regardless of insurance income Don’t offer trauma services 911 Receiving Facility CMS certifies as off-campus Emergency Department Joint Commission accreditation provided through the affiliated hospital 18
• • • • • • • • • •
Center for Comprehensive Care Free-Standing Emergency Department
Division of Lenox Hill Hospital 24-hour access to Board-Certified Emergency Physicians; 24-hour access to specialist consultations through North Shore LIJ’s physician network; Inpatient beds for stabilization and clinical decision unit; 911 receiving facility based upon protocols developed with EMS medical control; Rapid transfer via the North Shore-LIJ ambulance network to an appropriate receiving hospital chosen by the patient or Lenox Hill Hospital; On-site imaging, diagnostic and laboratory testing capabilities; A Picture Archiving and Communication System (PACS) that will transmit images to North Shore-LIJ radiologists, who will quickly interpret results; An inter-operable Electronic Medical Record accessible to all providers in North Shore-LIJ network who provide post-visit care to the patient; The ability for patients to actively participate in their care and decide which doctors or hospitals they will go to for follow-up care 19
• • • • •
Center for Comprehensive Care Free-Standing Emergency Department
Coordinated follow up care to either the patient’s physician, a neighboring primary care provider or a range of specialists; For those returning home who require in-home assistance, access to the home care provider of their choice or services provided through the North Shore-LIJ Home Care Network; Follow up referrals to manage a patient’s chronic conditions or other medical issues discovered during the course of treatment; Referrals to preventative care or education and support programs that will help avoid illnesses or injuries from worsening; An emergency care center that is accountable and meets all the same regulatory standards as traditional on-site hospital emergency departments (The Joint Commission Accreditation, NYS Article 28 and US Centers for Medicare and Medicaid Services). 20
Compliance with Regulatory Requirements
• • • • • • An emergency care center that is accountable and meets all the same regulatory standards as traditional on-site hospital emergency departments EMTALA 911 Receiving and EMS NYCRR Title 10 – Emergency Department and Services • 405.19
• 708.5 (h) – New Hospital Construction • 712-2.4
CMS hospital off-campus Emergency Department Regulations – 42 CFR 413.65
The Joint Commission Accreditation 21
Free-Standing Emergency Department will meet the same NYS regulatory standards as an on-site hospital emergency departments
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Recognized by the Centers for Medicare and Medicaid Services (CMS )
• • • CMS provides requirements for Provider-based Off-campus Emergency Departments Must demonstrate compliance with the hospital Conditions of Participation and with the provider-based regulations at 42 CFR 413.65. Demonstrate how the off-campus emergency department will meet the emergency needs of its patients in accordance with accepted standards of practice for hospital emergency departments. 23
North Shore-LIJ Emergency Department Capabilities
Similar to that of a community hospital, including advanced life support services, our emergency clinicians will be able to treat a full range of illnesses and injuries, including —but not limited to—the following: • Chest pain • Other cardiac symptoms • Early-onset stroke • Shortness of Breath • Respiratory illnesses – Asthma – Pneumonia – Chronic Bronchitis – Emphysema • Concussions • Fractures and joint injuries • Minor motor vehicle injuries • Severe cuts and burns • Abdominal pain • Allergic reactions • Ear infections • Gastrointestinal illnesses • Influenza (flu) • Occupational injuries • Sports injuries • Behavioral health 24
Triage, Treatment Protocols and Transfer Agreements
• • • Will work with DOH and EMS to develop medical protocols with respect to which patients are appropriate to receive care at the Center.
Exclusions as per 405.19 (3): – Trauma and multiple injury patients; – Burn patients (moderate to major); – High-Risk maternity patients; – Neonates or Pediatric patients in need of intensive care; – Head-injured or spinal-cord injured patients; – Acute psychiatric patients; – Replantation patients; – Dialysis patients, and; – Acute myocardial infarction patients including those with ST elevation.
Transfer Agreements will be developed with Beth Israel, Bellevue (Trauma), NYP-Weill/SIUH (Burns) 25
Free-Standing ED Demand Model
PSA SSA-I SSA-II Service Area Service Area '09 SVCMC Projected ED Treat & Release Share T&R 27,405 12,290 47,477 55.1% 17.3% 4.6% 15,100 2,126 2,184 87,172 22.3%
19,410
Projected ED T & R Visits 25% Inmigration 1 6% Admitted 2 Sub-Total 3% annual growth for 5 years Total
19,410
6,740 1,652 27,802 4,116
31,918
1 In 2009, SVCMC ED Inmigration was 59% 2 In 2009, SVCMC Admitted 22% of ED visits 26
FQHC, DTC, Extension Clinics and Comprehensive Clinics
Beth Israel Medical Center Chelsea Medical Practice and Sr. Health (PCP Clinic) 277 8 th Avenue, NY 10001 West Midtown Management Group 311 West 35 th Street, NY 10001 Mount Sinai Hospital Bayard Rustin Education Complex (PCP Clinic) West 18 th Street, NY 10011 Callen Lorde Community Health Center 356 West 18 th Street, NY 10011 Village Care Health Inc 121A West 20 th Street, NY 10011
There are 41 Article 28 licensed providers in the Service Area. Most of the licensed ambulatory providers are north and east of Center for Comprehensive Care. VillageCare and North Shore-LIJ have a strategic partnership for the provision of urgent care services.
Legend ABC ABC
Primary Service Area Secondary Service Area Diagnostic and Treatment Centers (DTC) Comprehensive Clinics Hospital-based Extension Clinics Federally Qualified Health Centers (FQHC) Center for Comprehensive Care Source: NYS DOH ( http://www.health.state.ny.us/nysdoh/hcra/provider/provamb.htm
); accessed August 2010 27
Redeveloping a Landmark for 21
st
Century Healthcare
Reconciling two public goals
: • Landmark – Preserve this historic structure • Healthcare – Design for 21 st century medicine
HISTORICAL CHALLENGES • Iconic design, dating to 1964, designed as a union hiring hall • Subsequent SVCMC adaptation to clinic not workable to today’s HC delivery • Subject of intense community attention and support • Original design is largely unchanged, and has aged • Deteriorating exterior materials • Building envelop is not energy efficient
LANDMARKS PRESERVATION • • • Subject to LPC review, seeking “Certificate of Appropriateness”
Restrictions on modifications to building exterior Cannot demolish and replace with a more efficient building
•
LPC process will impact renovation costs
• Vertical expansion is severely limited
Original floor plan DESIGN CHALLENGES Elliptical Plan Difficult to Secure • • •
Significant structural work needed to insert ambulance bay Need to reshape first floor to insert ambulance bay and public entrance Shear wall element frustrates adaptation
DESIGN CHALLENGES • Double façade (concrete panels and window wall behind) costly to repair • Minimal fenestration at upper floors
INFRASTRUCTURE CHALLENGES • Mechanical / Electrical systems need replacement • Low floor to floor heights (first & second floors) • Significant abatement scope • Need structural reinforcement to support major equipment • Elevators need replacement and relocation • Need to replace/relocate two stairs
INFRASTRUCTURE • Mechanical / Electrical systems need replacement • Low floor to floor heights (first & second floors) • Significant abatement scope • Need structural reinforcement to support major equipment • Elevators need replacement and relocation • Need to replace/relocate two stairs
SITE CHALLENGES • Open space to the south makes the building very visible from afar • Proximity to subway inhibits entry design at 7 • Lot line adjacency to neighboring buildings • Existing plinth/fence need replacement th Avenue • Proximity to subway entry requires extra care during construction
Preliminary Study
PROGRAM •
Emergency Department
• Imaging Diagnostic and Treatment unit (MRI, CT, US, Radiology, Mammo) • Ambulatory Surgery and future Angiography • Physicians Practices (future) • Clinical Services and Building Support
Preliminary Study
PROGRAM • • Emergency Department
Imaging Diagnostic and Treatment unit (MRI, CT, US, Radiology, Mammo)
•
Ambulatory Surgery and future Angiography
• Physicians Practices (future) • Clinical Services and Building Support
Preliminary Study
DESIGN CONCEPT • Ensure easy comfortable access for patients and ambulances • Continuing and improving use of natural light with new glass block / windows • Developing access to upper floors with a new entrance/lobby at W. 13 th st.
• Ensuring patient/visitor comfort with building environmental control systems
Preliminary Study 7 th Avenue – Walk-in Entrance
DESIGN CONCEPT •
Ensure easy comfortable access for patients
and ambulances • Continuing and improving use of natural light with new glass block / windows • Developing access to upper floors with a new entrance/lobby at W. 13 th st.
• Ensuring patient/visitor comfort with building environmental control systems
Preliminary Study W. 13 th Street – Patient Entrance
DESIGN CONCEPT • • Ensure easy comfortable access for patients and ambulances • Continuing and improving use of natural light with new glass block / windows
Developing access to upper floors with a new entrance/lobby at W. 13 th st.
• Ensuring patient/visitor comfort with building environmental control systems
W. 12 th Street – Ambulance Entrance Preliminary Study
DESIGN CONCEPT •
Ensure easy comfortable access for patients and ambulances
• Continuing and improving use of natural light with new glass block / windows • Developing access to upper floors with a new entrance/lobby at W. 13 th • Considering inclusion of skylight to bring natural light to the upper floors st.
• Ensuring patient/visitor comfort with building environmental control systems
North Shore-LIJ Comprehensive Care Center A New Hybrid Model of Care to Deliver 21
st
Century Medicine
• To better align community needs and resources, the Commission recommends that the state and industry collaborate to test and develop new “hybrid” delivery models. • Such hybrids would maintain features of a traditional hospital determined to be necessary while eliminating redundant and unneeded features. • Creative and financially viable alternatives,
such as free standing emergency rooms
or community health centers with urgicare capabilities, could advance the achievement of a right sized and restructured health care delivery system. • The benefits could include enhanced access to services, less duplication, and amelioration of the economic impact of full hospital closures.
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