Brief Overview of the. Grady Health System. Medical Staff & Clinical Issues

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1 Grady Health System Brief Overview of the Grady Health System Medical Staff & Clinical Issues Curtis A. Lewis, M.D., MBA, J.D. Senior Vice President, Medical Affairs Chief of the Medical Staff

2 Over 110 years ago, Henry W. Grady proclaimed that a healthy workforce was essential for Southern industry to be competitive in the marketplace Today, Grady Health System is the embodiment of his vision ensuring Atlanta s workforce has essential access to healthcare

3 Grady Health System (GHS) Delivers comprehensive inpatient & outpatient services to the underserved populations in Georgia Hospital supported by Fulton & DeKalb Counties Provides health-care to an 11-county in metropolitan area Largest Public Healthcare Safety Net in state of Georgia Served over 150 counties of Georgia last year Excellent healthcare services with 10 Centers of Excellence

4 Grady Health System Grady Memorial Hospital 25,000-30,000 patients admitted annually Approximately ,000 babies delivered Approximately 900,000 Outpatient visits annually

5 Clinical Services Many of the Clinical Services at Grady Health System are recognized nationally and even internationally for the excellent care they provide. These include but are not limited to: The Infection Disease Program The Diabetes Program The Trauma Services The Grady Burn Unit The Neurology/Stroke Program The Sickle Cell Disease Program

6 Services of the GHS Grace Towns Hamilton Women s & Infant s Pavilion Rape Crisis Center The Burn Center Teen Center Diabetes Detection & Control Center Georgia Cancer Coalition Center of Excellence

7 Support Services of the GHS Cont Crestview Health & Rehabilitation Center Ponce De Leon Center - Infectious Disease Program Edward C. Loughlin, Jr. Radiation Oncology Center The Manuel J. Maloof Diagnostic Imaging Center The Poison Control Center Nurse Advice Line Georgia Sickle Cell Center

8 Neighborhood Health Centers 1. Asa G. Yancey, Sr. M.D. Health Center 2. Center Hill Health Center 3. DeKalb Grady Health Center 4. Grady Health Center East Point 5. Grady Health Center South DeKalb 6. Lindbergh Women s & Children s Health Center 7. North DeKalb Health Center 8. North Fulton Health Center 9. Otis W. Smith, M.D. Health Center

9 Grady Health System Locations

10 The Clinical Partnership Emory University Morehouse School of Medicine Deliver Clinical Services Educate tomorrow s Clinicians Research

11 Grady Health System Staffed by physicians from Emory University School of Medicine & Morehouse School of Medicine approximately 1,100 credentialed physicians on the Medical Staff at Grady Health System. Approximately 325 Attending Physicians provide services and supervise clinical services on a daily basis Approximately 25% of all physicians practicing within Georgia trained at GHS Over 50% of all physicians received some training at GHS Major training and research center

12 Education and Training at Grady Health System in many areas including but not limited to: Graduate Medical Education Medical Students Physician Assistants Nursing Students Radiology Technologists Ultrasonographers Anesthetists Radiation Oncology Technology Pharmacy Students

13 Graduate Medical Education The Health System provides Graduate Medical Educational training in multiple specialties and subspecialties of Medicine and Surgery. Grady Health System is integral to the Graduate Medical Education Programs at both Emory and Morehouse. On a daily basis there are approximately 460 residents training and providing clinical services at Grady Health System. This represents approximately 370 residents from Emory and 90 residents from Morehouse School of Medicine. Grady is involved in the training of nearly 1000 different residents on annual basis.

14 Graduate Medical Education The clinical training provided at Grady is a key component of many of the residencies for both medical schools. Grady Health System is a critical location for Medical Student Education of both medical schools On any given day there are approximately 200 medical students on the Grady Campus. Some of the experience provided at Grady is not available at any of the other clinical training sites.

15 Overview of Medical Services The Hospital Governance (Board of Trustees) has the ultimate responsibility and legal authority for: the safety and quality of care, treatment, and services to patients and needs to provide the necessary resources. (The Joint Commission, 2008 Hospital Accreditation Standards). The Governance is required to establish policies that promote performance improvement and provide for organizational management and planning. The Joint Commission also requires that the hospital have an organized, self-governing medical staff that oversees the care, treatment and services provided by practitioners with privileges.

16 Overview of Medical Services The Medical Staff is required to provide for a uniform: quality of patient care, treatment and services and must report to and be accountable to the governing body (The Joint Commission, 2008 Hospital Accreditation Standards). The Senior Vice President of Medical Affairs serves as the liaison officer and channel of communication for all official communications between the Board of Trustees and the Medical Staff. Chairs the Medical Exec. Comm. The Medical Executive Committee comprised of the Chiefs of the Clinical Services of the Grady Health System, serves as governing body of the Medical Staff.

17 Quality Performance Improvement Structure BOARD QUALITY OVERSIGHT COMMITTEE TOP QUALITY COMMITTEE MEDICAL EXECUTIVE COMMITTEE QUALITY FOCUS TEAM PERFORMANCE IMPROVEMENT TEAMS

18 Overview of Medical Services The Medical Executive Committee accountable to the hospital s Governing Body for The professional performance and ethical conduct of all its Members. For coordinating the activities of the Services to facilitate the provision of quality patient care at GHS by conducting Peer Review and participating in organizational Performance Improvement activities The Medical Executive Committee is a professional review body as such term is defined under Section 431 (11) of the Health Care Quality Improvement Act of 1986.

19 Overview of Medical Services The MEC shall advise the Board of Trustees on the qualifications necessary for a Member of the Active Medical Staff to perform as Chief of Service. The MEC shall also make recommendations to the Board of Trustees regarding granting and revocation of appointments, reappointments, privileges of physicians to the Medical Staff,

20 Overview of Medical Services The Medical Executive Committee serves to provide: professional direction to GHS, to develop excellence of patient care, to maintain the proper atmosphere for teaching, and to encourage research. Subject to the approval of the Board of Trustees, the Medical Executive Committee also is responsible for the functioning of the clinical organization of GHS, and is required to provide careful supervision of all of the clinical work done at GHS.

21 Overview of Medical Services The Medical Executive Committee also oversees and receives reports from the standing committees of the MEC. Examples of some of the standing committees of the Medical Executive Committee include: The Credentials Committee. The Cancer Committee. The Infection Control Committee. The Pharmacy and Therapeutics Committee. Patient Safety/Medical Errors Reduction Committee.

22 Clinical Services at Grady Health System Anesthesiology Dental Dermatology Emergency Medicine Extended Care Family, Community and Preventive Medicine Gynecology and Obstetrics Laboratory Medicine Medicine Neurology Neurosurgery Orthopedics Ophthalmology Otolaryngology Pathology Pediatrics Psychiatry Radiation Oncology Radiology Rehabilitation Medicine Surgery Urology

23 Medical Leadership Grady Health System Senior Vice President of Medical Affairs Deputy Senior Vice President of Medical Affairs Chiefs of Service Medical Schools President/Executive Vice-President Deans Executive Associate Dean Associate Deans Chairman

24 Physician Concerns Service Chief Survey

25 Challenges to the Delivery of Quality Care Resources Equipment / IT Facilities / Space People / Staffing

26 Challenges to the Delivery of Quality Care Information Technology * Patient safety Patient tracking Quality monitoring Availability of patient information (ML) Essential Solutions EMR / PACS Clinical data warehouse Patient Tracking Systems RFPs due back on

27 Challenges to the Delivery of Quality Care Medical Equipment* Aging of Equipment - Radiology Diagnostic and Therapeutic (1992) New Angio Equip on Site Need New CT Scanner Other Medical Equipment (Urology, Surgery) Stretchers / Beds / wheelchairs, ect. Lifecycle of Medical Equipment Standard of Care Obtaining Competitive Edge Educational and Research

28 Challenges to the Delivery of Quality Care Patient and Family Friendly Facilities Crestview Surgical Clinic Oral Surgery Clinic ICU waiting areas Other Buildings on Grady Campus Space Constraints Urology GI Services- Trauma Services / ICU capacity Pharmacy Oral Surgery

29 Challenges to the Delivery of Quality Care People / Staffing Physicians Factors impacting GHS physician mix Support of Physician Services Equipment and IT challenges Medical staff reassigned or not replaced Specific Shortages Skill Sets ( Ophthalmology, GI, Urology) High Priced Subspecialties (Interventional Card, NeuroSurg, CT Surgery)

30 Service Issues Ophthalmology Urology Interventional Cardiology Services GI Services Recruitment on going (MSM 2 new Faculty) Orthopedics Recruitment ( 3 New Faculty-Fall 2007)

31 Challenges to the Delivery of Quality Care People / Staffing Nursing Overall Shortage (National) ECC NICU (Special Skill Sets) Ancillary / Allied Health Physical Therapist Pharmacist Speech Therapist Physician Assistants

32 Challenges / Opportunities Growing Number of Uninsured Growing Population of Atlanta Growth in both total number and the uninsured has far out paced the growth in resources to handle this growth Decreasing Financial Resources Increasing Debt Customer Service Issues Competitive Environment For Patients Dollars Human Resources Physicians Staff

33 Challenges / Opportunities Managed Medicaid Challenging to everyone dealing with this population. Changing Demographics Change in Environment Influences Revitalization of Downtown and Midtown Growth and Expansion of Area Hospitals Increasing breath of Services via Helipad and Burns Increasing Hispanic Population New legislation restricting delivery of care

34 Grady Health System Centers of Excellence Trauma Burn Center Neonatal Intensive Care Infectious Disease Center Breast Health Initiatives (1996 NAPH 1st Place Safety Net Award) Radiation Oncology Center Imaging Center Asthma & Allergy Clinic Sickle Cell Treatment Program Diabetes Detection & Control Center (1997 NAPH 1st Place Safety Net Award)

35 Trauma Care in Georgia

36 Trauma Hospital inpatient trauma care in Georgia has grown from $835 million in charges in 1999 to an estimated $1.5 billion in This is a growth of 83% in only five years. During this five-year period the uninsured charges to Georgia hospitals has increased from $122 million to $188 million per year. This is a five-year loss of $770 million to Georgia hospitals. This means that many of rural counties in Georgia no longer have emergency healthcare facilities available to them. A one-hour ride to a hospital instead of 15 minutes could mean the difference between life and death for a patient in need of emergency care.

37 Motor Vehicle Accidents Motor vehicles accidents account for more deaths in the United States than all natural disasters combined. Uninsured hospital trauma care charges for vehicle accidents have increased by 60% since 1999 in Georgia. These accounts for almost half of all trauma care required in Georgia. Vehicle fatalities in Georgia from 1992 to 2001 have increased 25%. In 2000 the economic cost of motor vehicle crashes in Georgia was $7.8 B Pedestrian death accounts for 13% of the vehicle accident deaths. Metro Atlanta is the third most dangerous in the U.S. for Ped. v MV Uninsured charges from vehicle accidents have grown the fastest of any group.

38 Uninsured Trauma Charges in Georgia for Vehicle Accidents Total Uninsured Loss for the Period $360,082, % Uninsured Trauma Charges in Georgia for Accidental Falls & Injuries Total Uninsured Loss for the Period $233,826, % Uninsured Trauma Charges in Georgia for Penetrating Injuries Total Uninsured Loss for the Period $176,188, % Total Uninsured Trauma Charges in Georgia Total Uninsured Loss for the Period $770,097, % Data Source is HeRMES.

39 Grady Remains: Home to the only Trauma 1 Center within 100 Miles Home to one of Only Two Burn Units in the State Home to one of the top 3 Infectious Disease Programs in the United States Home to the greatest capacity and skill set to handle man made or natural Disasters. The only Safety Net Hospital in this region not only for those things mentioned but to serve the underserved, the indigent and anyone who is need of Health Care and cannot afford it including each of us and our families.

40 Current Issues of Importance The Joint Commission EMS Funding Elimination Medical Schools Match Results New Capital Money

41 The Joint Commission The Joint Commission Survey & Process The Grady Health System (GHS) has been officially notified by The Joint Commission (TJC) of its preliminary recommendations from the onsite survey conducted this past November The requirements for improvement (RFIs) have been reduced to reflect fewer than those initially noted at the conclusion of the survey itself.

42 The Joint Commission The Health System now must address each of the RFIs in accordance with The Joint Commission s accreditation process. The organization is currently fully accredited and we expect to remain so once we successfully complete the TJC accreditation process. Multidisciplinary target (action) teams have been organized since the end of November and are actively working to ensure that we will indeed be able to meet the expected deliverables.

43 The Joint Commission The following are the charges to the teams: To ensure that our policies and practices are consistent with the intent of the cited standard (and its elements of performance); To ensure that the policies and/or practices are consistently implemented throughout the Health System; To establish a baseline for our compliance to the standard (if one does not exist) and to track our progress; To identify and address barriers to standard sustainability.

44 Grady Emergency Services EMS Funding Elimination November 7, 2007: Fulton County Board of Commissioners voted to eliminate all funding for 911-ambulance services effective July 1, The elimination of the $6.7 million in supplemental funding from Fulton County represents a 30% reduction in the GEMS budget The total budget is approximately $22 million of which $15 million is covered by collections).

45 Emergency Services After factoring for fixed costs, this will mean a 60% reduction in the number of ambulances on the street» Response times for life threatening emergencies will likely exceed 30 minutes and may be much longer» All ambulances will be tied up on a call 88% of the time. Stated another way, there will be no ambulances available for immediate response across the entire city 88% of the time.» If Grady decides to attempt to provide services with the funding reduction, ambulances will be constantly busy and a long line of people will be waiting for someone to respond to their emergency.

46 Emergency Services There will be a significant clinical impact for people in need of immediate emergency medical services. Survival for out-of hospital cardiac arrest will be non-existent Trauma patients and patients having heart attacks, strokes and other severe problems will likely suffer more complications and may die because of delayed ambulance transport to the hospital. There will be a significant increase in preventable disability and death in the City of Atlanta.

47 Medical Schools Match Results Both Medical Schools had strong recruitment classes that are to start July 1, They have both filled all their available positions with strong candidates. Emory will be starting 225 new residents in 27 different residency programs; Morehouse successfully filled 34 positions in 9 different residency programs. Both schools are pleased with the success of their recruitments and with the excellent quality of trainees that they were able to attract.

48 New Capital Money Physicians are eagerly anticipating the availability of new capital monies and have been active in developing a plan with the administration to prioritize and coordinate the purchase of clinical equipment.

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