North Shore Care Center Nursing Director Helena Blake gave a presentation to the hospital board September 16, 2010 on a federally required assessment tool that is routinely used to develop care plans for residents.
Care plans are updated at least quarterly and whenever a resident’s condition changes significantly. The assessment tool, called a Minimum Data Set (MDS), documents health conditions, pain level, cognition, mood, mobility, medications, interventions, nutrition, and goals, but it also asks residents about their preferences.
An entire page of questions focuses on how important various aspects of daily life are to the residents, such as choosing what clothes they wear, having snacks available between meals, choosing their own bedtimes, being able to use the phone in private, having family or friends involved in discussions about their care, listening to music they like, being around pets, keeping up with the news, and getting fresh air when the weather is nice.
Blake stated in a PowerPoint presentation, “We use the assessment to tailor our services to each individual’s needs and preferences. It is the foundation for each resident’s plan of care.
“The federal assessment, which is identical throughout the country, has contributed to … improvement in the provision of care and services for residents of care centers. For example, there have been significant decreases in the number of pressure ulcers that develop in care centers and the number of physical restraints used.”
According to Blake, the assessment tool has increased resident and family participation in care planning and promoted a team approach among the staff.
An updated version of the MDS will be used starting October 1. “In this new assessment,” Blake said, “we will be asking each resident more questions in order to get a better understanding of the individual’s perspectives and experiences, desires, and goals. …We will ask questions so we can incorporate the individual’s lifestyle preferences and promote enjoyable and meaningful activities.”
The MDS is used to determine the level of care needed and to facilitate accurate billing. Nurse Mark Abrahamson is the Care Center’s full-time MDS coordinator.
Financial report
The hospital and care center were at a $67,000 lost for the year as of the end of August. Controller Yvonne Gennrich said it was “pretty exciting” to be on track with expected losses. Losses are not good, she said, but at least the situation is no worse than expected.
Board member Howard Abrahamson pointed out that a large part of the loss is in the form of building and equipment depreciation. He wondered how this might affect the appearance of financial losses. “I’m concerned about our levy,” he said, referring to the possibility that the levy could be increased almost threefold next year from $425,000 to $1.2 million.
The average monthly inpatient revenue for the last 12 months was $95,591, down $50,919 from the 12-month average at this time last year, which was $146,510. Also down were outpatient (emergency room) and home health revenue, but up from last year were swing bed and care center revenue. Overall, the average monthly income was down $52,941 in the last 12 months, at $1,123,014 compared to $1,175,955 at this time last year.
St. Luke’s President/CEO John Strange, who has been attending North Shore Hospital board meetings since an administrative partnership was struck between the two hospitals, said business has been down at St. Luke’s as well as other hospitals in the region and even in the Twin Cities.
Regarding the effect of the economy on usage of health care services and ability to pay for them, Sawtooth Mountain Clinic Administrator Rita Plourde said, “Our sliding fee scale usage is increasing pretty dramatically.”
New reimbursement
program
At her first meeting as hospital administrator, Kimber Wraalstad discussed with the board a new funding mechanism called “Equitable Cost- Sharing for Publicly Owned Nursing Facilities” (ECPN) offered by the Minnesota Department of Human Services (DHS) that resulted from changes in the law made during the 2010 legislative session.
According to a June 28 DHS bulletin, “The ECPN program was established as a mechanism to allow non-state governmental entities that own a nursing facility and choose to contribute funds to the operation of that facility to receive federal match for those contributions.”
Under this program, a nursing home would get $3 back for every dollar it sent to the state. Theapplication had to be received by September 30 and would be irrevocable. Once in the program, the hospital would be required to stay in it for five years. Any Minnesota nursing facility whose physical plant was owned by or whose license was held by a city, county, or hospital district was eligible, which DHS estimated would be 45 facilities.
Wraalstad said participation in the program would result in greater cost to private-pay residents, which numbered 17 at the time. “Thiswill more accurately reflect the cost of the service they’re receiving,” she said.
Controller Gennrich said the Care Center has been losing about $1.7 million a year for several years. This program is expected to help the facility reduce its losses. St. Luke’s vice president Sandra Barkley said it could buy them time until they figure out other options for solvency.
The board voted unanimously to apply for the ECPN program. Board member Tom Spence was not at the meeting.
Dialysis
Administrator Wraalstad reported that after investigating the possibility of providing dialysis services, she informed the person who requested it that offering dialysis would not be financially viable at this time.
Truth-in-taxation meeting
The hospital board will hold a truth-in-taxation meeting Thursday, December 23 at 9:30 a.m. The2011 levy will be discussed.
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