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' 1 Board of County Commissioners
NCMC Board of Trustees
meTo Weld County Health Board Date January 15, 1985 9 .
COLORADO From Jackie Johnson, County Commissioner
Health Department/Hospital Joint Study-am Committee
subject:
Attached please find the Final Report of the Health Department/Hospital
Joint Study Committee, unanimously approved by the committee members present
on January 14, 1985. The report summarizes the committee's work and
recommendations that resulted from the four months of study. Hopefully, the
report will be a useful document in assessing current and future
relationships between NCMC and the Health Department.
If any Board would like to discuss the report, Dennis Xohan or I will make
ourselves available. If agreeable to the groups involved, representatives
from each Board on the committee will take the initiative to call a .joint
meeting in July, 1985 in accordance with the final recommendation of the
report.
cc: Committee Members
850950
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MINUTES
HEALTH DEPARTMENT/HOSPITAL JOINT STUDY COMMITTEE
January 14, 1985
PRESENT:
Jackie Johnson, Chairperson
Dr. Ralph Wooley
Dennis Kohan
Lynn Brown
Tom Baur
Don Warden
Wes Potter
Jacque Meyer
Minutes of the last meeting were approved.
Jackie Johnson distributed a draft of the final report. The committee
members discussed the report. Amendments were made to clarify the seventh
recommendation from the F.P.R.P. Sub—Committee and Aims' involvement in
childbirth classes.
An addition regarding hospital overhead cost was added to the final
paragraph of the report.
Dennis Kohan made a motion to present the report to the Board of County
Commissioners and NCMC Board of Trustees, as amended and corrected, with a
second by Tom Baur. The committee passed the motion unanimously.
Jacque Meyer will discuss the report at the next Health Alliance meeting to
be held on January 17, 1985.
Jackie Johnson, Dennis Kohan, and Tom Baur will jointly initiate a meeting
of their respective Boards in July, 1985 in accordance with the final
recommendation.
Final meeting adjourned at 1:00 p.m.
FINAL REPORT
HEALTH DEPARTMENT/HOSPITAL JOINT STUDY COMMITTEE
A committee was created by the Board of County Commissioners and the Board
of Trustees of NCMC September 5, 1984. The committee members included the
following individuals:
Commissioner - Jackie Johnson
Director of Public Health - Dr. Ralph Wooley
Health Board - Lola Fehr
Private Practitioner - Dr. Ed Baldwin
Hospital Board - Dennis Kohan
Hospital Staff - Lynn Brown
Health Board - Tom Baur
The charge of the committee was to evaluate the potential for cooperative
and coordinated health programs offered by NCMC and the Weld County Health
Department to best meet the public health needs of the citizens of Weld
County. The study approach included the examination of programs and
services offered by both entities, duplication of services, financing of
services, community health needs, and potential for consolidation and/or
improved coordination of service delivery.
At the October 1, 1984 meeting of the committee Tom Baur presented the
results of the Health Department needs survey committee. The general
conclusion of the committee was that the Weld County Health Department does
a remarkably good job of supplying a wide range of important, cost effective
public health services to the community. It is an efficient, lean, well
managed organization with an enthusiastic and conscientious staff.
The need for almost all services of the Department can be expected to
increase substantially in the next five years. The reasons for this
increased need include:
1. An expected 25% increase in the general population,
2. An even larger percentage increase in the population of the very
young and very old, both groups that are traditionally heavy users
of public health services, and
3. An expected increased industrialization of the county, which will
increase the production of potentially harmful waste products.
Dr. Thomas M. Vernon, Director of the State Health Department, attended the
October 15, 1984 meeting to give an overview of public health. Dr. Vernon
philosophically believes public health has a duty to know the health status
of the community, which is a surveillance responsibility of the entire
community population. Public health also addresses the needs of special
populations. Public health is a government responsibility and fulfills a
societal need. Questions Dr. Vernon said must be asked are: (1) "Is public
health doing too many things?" (2) "When is what is being done no longer
necessary to be done?" and (3) "Is public health doing the necessary things
today, or should it be shifting resources to other health areas or
problems?" Public health agencies must balance delivery of service with
other health agency needs. Issues Dr. Vernon raised are:
1. Can specific populations be served in ways they need to be served?
2. Public health has and should target groups less likely to access
services of the medical community. Its range of services extends
from recruitment to medical treatment, to follow up.
3. When health services are provided by an outside agency, does that
organization have the continuity of services to provide all
necessary services?
4. Dr. Vernon compared public health and acute health care by using
an example of a numerator/denominator. In an acute care setting,
the individual patient (numerator) is the focus, whereas public
health is concerned with "Rate" medicine, i.e. , the numerator
(individual) in the context of the denominator (entire community) .
At the November 5, 1984 meeting Jim Kadlecek, NCMC Trustee, gave the
committee the background and an overview of the NCMC reorganization. Mr.
Kadlecek pointed out that NCMC has a charter responsibility for care of the
indigent in Weld County. The restructure is a reaction to the market and
service area changes to avoid: (1) refusing services to indigents;
(2) asking state, federal, or local governments for assistance; and
(3) diminished care to all patients.
The restructure of NCMC hopefully will provide the legal mechanism to
capitalize on the expansion and development of services. The structure
calls for a holding company (Normedco) and subsidiary corporations that are
not-for-profit and for-profit. Revenues from the subsidiaries can then be
channelled back to NCMC.
At the October 15, 1984 meeting three sub-committees were formed to focus on
identified areas of mutual concern to the Weld County Health Department and
NCMC. The sub-committee summary reports were as follows:
Family Practice Residency Program:
The Family Practice Residency Program Sub-Committee report given by Dr.
Ferguson indicated that there are twelve residents, four in each year. The
program has three full-time faculty and a medical director, plus local
physicians who make special presentations and are consulted by the
residents. NCMC subsidizes the program approximately $425,000 per year. In
addition to in-patient experience with unassigned patients, residents
receive out-patient experience in their Family Practice Clinic, in the
Keenesburg Clinic, at the Health Department, and through a rural
preceptorship.
The F.P.R.P. provides the community with the following advantages:
1. Community Service
2. Reduces use of emergency room as a clinic
3. Educational program benefits, whole medical community
4. Increased level of care in the community
5. Provides house staff to NCMC
6. Supplements ER coverage
Key issues identified by the F.P.R.P Sub-Committee:
1. The Family Practice Residency Program provides a needed service to
the Health Department and to the community through its service to
the Health Department clinics.
2. The Family Practice Residency Program, in addition to the service
provided, also receives valuable educational training through the
participation in the Health Department clinics.
3. The continuation of this service is important both for the Family
Practice Residency Program and the Health Department.
4. The financial contribution being made by the Family Practice
Residency Program to the people of Weld County should be
recognized.
5. Health Department clinics should stay intact at the Weld County
Health Department because staff is not available for paper work or
patient contact time at the Residency Program.
6. Residents should take a more active role in all Health Department
needs and clinics, both in Greeley and in Ft. Lupton.
7. If the proposed contract for full reimbursement of residents is
actively sought from Health Department funds, other alternatives
should be looked at by the Health Department.
Laboratory:
The Laboratory Sub-Committee explained that the laboratories vary in many
ways because their missions are different. The NCMC lab's focus is on the
diagnosis of illness and assessment of health of individual patients, while
the Health Department lab is concerned with large segments of the
population. While all lab tests at NCMC are medical in nature, only about
15% of the Health Department's resources are devoted to medical testing.
Staffing needs also vary since the NCMC lab must operate 24 hours a day.
Cost comparisons of tests performed by both labs found it very difficult to
find valid comparative figures. The NCMC lab could do the additional work
of the Health Department with no increase in staff for an actual incremental
cost of about $6,000. However, they estimated they would bid about $12,800
to do this work.
The report concluded that the medical laboratory should be maintained at the
Health Department, but that stool cultures be contracted with NCMC. Another
look should be taken at some future time as the environmental work load at
the Health Department increases. At that time the Health Department could
consider shifting some medical work to NCMC rather than adding personnel.
It was also recommended that the Health Department continue to consult NCMC
before purchasing substantive new equipment.
Health Education:
The Health Education Sub—Committee reported that the goals and objectives of
both agencies focus first on their client populations, and then branch into
the community. It is in the community that duplication is a possibility,
but the costs of the programs appear to draw differing populations.
Programs which are common and, at least on the surface, duplicative, are the
stop smoking and car seat programs. Even these have differing qualities.
The well oldster programs are coordinated by Aims, and therefore are part of
a single entity. The hospital, through Aims Family and Life Education
Program, conducts childbirth preparation classes which may be attended by
teens but they have no other teenage pregnancy program or maternity clinics
at NCMC. There does seem to be some competition in the area of employee or
business and industry programs.
The cost funding methods differ between these providers. The hospital based
programs must factor in overhead at a rate of 123% for direct costs for each
program. The overhead for the health department is much less.
The hospital technically could perform the health education programs of the
Weld County Health Department. However, NCMC cannot add programs without
adding staff, and in the current situation it is unlikely the clients would
all transfer. The programs would be more costly under the hospital costing
methodology. The Health Department does not have resources to take on the
hospital programs.
A concern of both agencies is the growing role of other community agencies
in health education. UNC is very much moving into the community. Aims has
traditionally contracted with the Weld County Health Department and NCMC in
a cooperative way. A new private sports clinic is being established. The
City of Greeley plans to expand its program, and Bonnell is moving to offer
services to seniors in the community. CAHEC offers staff development in the
area.
Recommendations:
1. Current health education programs of both agencies should continue
according to the policy of their respective boards.
2. Coordinate Lamaze classes through Aims Family and Life Education
program with fee waiver application assistance as necessary for
Weld County Health Department clients.
3. Continue participation in the Health Promotion Network meetings
designed so that all county health educators may share plans for
new programs and coordinate services offered.
4. Share scheduling of staff development program between the Weld
County Health Department and NCMC, with the objective of avoiding
duplication. However, differing staff needs require specific
individual agency programs.
5. Health programs for the employees of business and industry should
be paid for by those employers.
The committee as a whole concurred with the conclusions and recommendations
of the sub-committees and forwards them to the Board of County Commissioners
and NCMC Trustees for information and consideration. The committee
concluded that benefits resulted from the above studies through improved
communication and better understanding of one another's programs. The
committee also found that the overhead figures charged for hospital services
created a barrier to the hospital and county departments working together on
certain services because of the additional costs. The committee concludes
by recommending that a semi-annual meeting between the hospital, the Board
of Health, and the Commissioners should be held to keep each other informed
and to discuss areas of mutual concern, cooperation, and coordination of
health programs offered by NCMC and the Weld County Health Department.
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