Success Healthcare 1, LLC dba Silver Lake Medical Center

Transcription

1 Training Proposal for: Success Healthcare 1, LLC dba Silver Lake Medical Center Agreement Number: ET Panel Meeting of: June 21, 2013 ETP Regional Office: North Hollywood Analyst: N. Weingart PROJECT PROFILE Contract Attributes: Counties Served: Retrainee Priority Rate Medical Skills Training Job Creation Initiative SET HUA Los Angeles Industry Sector(s): Healthcare Priority Industry: Yes No Repeat Contractor: Yes No Union(s): Yes No Number of Employees in: CA: 650 U.S.:1,800 Worldwide: 1,800 Turnover Rate: 17% Managers/Supervisors: (% of total trainees) FUNDING DETAIL 0% Program Costs - [Substantial Contribution] [High Earner Reduction] = Total ETP Funding $396,660 $0 $0 $396,660 In-Kind Contribution: 100% of Total ETP Funding Required $537,751 ETP Single (08/16/12) 1 of 7

2 TRAINING PLAN TABLE Job No. Job Description Type of Training 1 Retrainee Priority Rate Medical Skills Training SET HUA 2 Retrainee Job Creation Initiative Priority Rate Medical Skills Training SET HUA Medical Skills Didactic & Clinical Preceptor Computer Skills Continuous Improvement Medical Skills Didactic & Clinical Preceptor Computer Skills Continuous Improvement Estimated Range of Average Post- No. of Hours Cost per Retention Trainees Class / CBT Trainee Wage Lab $828 $20.03 Weighted Avg: $1,140 $16.00 Weighted Avg: 57 Minimum Wage by County: Job Number 1: $26.71 per hour statewide modified by 25% to $20.03 per hour for priority industries; and Job Number 2: $13.34 per hour for Los Angeles County. Health Benefits: Yes No This is employer share of cost for healthcare premiums medical, dental, vision. Used to meet the Post-Retention Wage?: Yes No Maybe $5.00 per hour may be used to meet the Post-Retention Wage. Wage Range by Occupation Estimated # of Occupation Titles Wage Range Trainees Registered Nurse 215 New Graduate Nurse 20 Licensed Vocational Nurse 71 Radiology Technician 17 Respiratory Therapist 20 Surgical Technician 5 Laboratory Technician 9 Medical Assistant / Technician 29 Clinical Pharmacist 16 Pharmacy Technician 13 ETP Single (08/16/12) 2 of 7

3 INTRODUCTION This will be the third Agreement between the Employment Training Panel and Success Healthcare 1, LLC dba Silver Lake Medical Center (SLMC) ( SLMC has two facilities with a total of 234 licensed beds: a general acute care hospital in Los Angeles (Downtown Campus); and a psychiatric facility in Rosemead (Ingleside Campus) dedicated to behavioral health services. The downtown campus historically serves a diverse population of urban poor in Los Angeles County. According to the Department of Health and Human Services, this is a disproportionate share hospital with approximately 70% of patients reliant on Medi- Cal. The geriatric patient population is increasing as a large segment of the baby boomer population ages. Downtown Campus (located in a High Unemployment Area) offers a variety of inpatient and outpatient medical-surgical services including Intensive Care Unit, GI Procedures Center, Laboratory Services, Physical Rehabilitation, Psychiatry, Radiology, Same Day Surgery, Telemetry, Urgent Care Center, and Post-Hospital Transportation. Downtown Campus also offers specialty services including Advanced Bariatric Center, Behavioral Health Services, Occupational Health Services, Podiatry Residency Program, Center for Vascular and Endovascular Surgery, The American Spine Institute and an Urgent Care Center. Ingleside Campus offers psychiatric services including Crisis Intervention and Stabilization, Assessments by Multi-Disciplinary Staff, Individualized, Goal Oriented Treatment Plans, Individual and Family Counseling, Education and Support groups, Stress and Anger Management, Medication and Health Management. SLMC Is a Panel priority industry (Nursing and Allied Healthcare) and will be funded under Special Employment Training (SET) provisions of Title 22, Section Under SET, the employer is not required to demonstrate out-of-state competition, and trainees must earn at least the statewide average hourly wage at the end of the retention period. SLMC is currently undergoing a variety of major internal changes and responding to several significant outside events. Closure of Local Hospitals - The unexpected closing of Los Angeles Metropolitan Medical Center, Bellflower Medical Center and Anaheim General Hospital resulted in a sudden influx of patients (particularly in behavioral health). Downtown Campus now averages 100% daily census. Growth of Specialty Programs - The orthopedic and neurospine programs provide state-ofthe-art care for patients with complex conditions. Surgeons manage cervical, thoracic and lumbar disk herniations, spinal cord compression, spine instability, trauma, and tumors utilizing the latest technologies and best practices against vascular disease. Bariatric surgery is increasing as obesity has become a critical health issue affecting approximately 30% of the US population alone, and is the second leading cause of preventable death. The hospital recently introduced a new procedure called Sleeve Gastrectomy that induces weight loss by restricting food intake. New Services - SLMC will introduce Palliative Care as a new service line. Palliative Care helps relieve suffering and improve quality of life, often through pain management and counseling techniques for patients with serious and life threatening illness. New Technology and Equipment - The hospital is expending approximately $950,000 in new equipment including: vascular Instruments, an ultrasound machine, ventilators, gastrointestinal ETP Single (08/16/12) 3 of 7

4 scopes, 16-slice CT Scanners, computers, and Pyxis Medication Dispensing System that will allow pharmacists to efficiently manage medications and access reports and key metrics. Also SLMC Electronic Medical Records (EMR) system is continually evolving. Customer Service - Under the Hospital Value-Based Purchasing Program, the Center for Medicare and Medical Services withholds 1% of its regular reimbursements to 3,000 acute care hospitals. That money (totaling about $850 million) will be redistributed to hospitals over the year if they meet high performance standards based on certain clinical quality measures and patient satisfaction survey results (Hospital Consumer Assessment of Healthcare Providers and Systems Survey.) Patient Protection and Affordable Care Act - The Patient Protection and Affordable Care Act (PPACA) is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care. It provides a number of mechanisms (mandates, subsidies, and tax credits) to employers and individuals to increase the coverage rate. PPACA is expected to create an inflow of patients into the hospital. Retrainee-Job Creation SLMC will be hiring and training approximately 100 Registered Nurses, 20 New Graduate Nurses, 30 Licensed Vocational Nurses, and other allied health personnel for both campuses. Because of its proximity to downtown Los Angeles, the company must compete for nursing staff with other inner-city hospitals that are part of larger chains and have greater resources. In order to fulfill nurse/patient ratios, the company must hire inexperienced nurses who are typically not prepared to assume responsibility for patient care. The company must train these nurses in extensive theory and practical, clinical knowledge (in some cases over 200 hours). In this proposal, SLMC has committed to hiring 170 new employees (Job Number 2). To be eligible for reimbursement, trainees must be hired within the three-month period prior to Panel approval or during the term of contract. In support of Job Creation, the Panel is offering incentives. Training for newly-hired employees will be reimbursed at a higher rate, and trainees are subject to a lower post-retention wage. Training Plan Didactic and Clinical Preceptor Medical Skills (80%) - Training will be delivered to all occupations. Training for incumbent and newly-hired workers will provide up-to-date skills in various medical disciplines to help staff meet or exceed quality care and patient safety standards. Some staff will be cross-trained in more than one discipline to facilitate new and expanding services. Computer Skills (10%) - Training will be offered to all occupations on the EMR system, Pyxis Machine, and Microsoft Office (intermediate/advanced). Continuous Improvement (10%) - Training for all occupations will address the customer service initiatives, teambuilding efforts, and performance and quality improvement efforts. Impact/Outcome Training will help SLMC meet increased inflow of patients, add new services and state-of-the-art equipment, facilitate the expansion and growth of existing services, improve customer service, guarantee financial incentives, and maintain a safe, patient-focused environment. ETP Single (08/16/12) 4 of 7

5 Training Infrastructure Training will begin upon Panel approval, and will be delivered by in-house experts as well as medical consultants and outside vendors. SLMC s human resources staff will provide all necessary enrollment and close out information, while the Education Department will ensure that classes are scheduled and rosters are completed properly. An outside vendor will interface with the hospital to ensure completion of all ETP administrative and recordkeeping requirements. Commitment to Training SLMC s California training budget is approximately $90, annually for classes ranging from new hire orientations to annual skills update training. To date, SLMC has focused on training to keep its facilities in compliance with healthcare regulations. The hospital has also provided a large number of EMR training hours to meet its conversion deadlines. The current ETP Agreement (ending in June 2013) allowed SLMC to stabilize and turnaround a business with dire beginnings and provide the foundation for growth (the nursing staff has grown from 85 to over 400). This new proposal, while utilizing much of the same curriculum, will further the education of incumbent staff and support recruitment and training of new staff, expansion of services, and profitability. Once this ETP project is complete, SLMC will re-evaluate employee needs and continue to provide new hire orientation training, as well as ongoing skills updates. SLMC represents that ETP funds will not displace the existing financial commitment to training. Safety training is, and will continue to be, provided in accordance with all pertinent requirements under state and federal law. Medical Skills Training The Panel has established a reimbursement rate of $22 per hour for nurse upgrade training, recognizing the higher cost of delivery for Didactic and Preceptor Medical Skills. SET Priority Industry Wage Modification For trainees employed in a priority industry, the Panel may modify the wage up to 25% below the statewide average hourly wage (from $26.71 to $20.03). This wage modification is requested to serve workers in lower wage occupations (Job Number 1). Training Hours Limitation Retraining is normally capped at 200 hours per trainee. However, the Contractor is requesting a modification to allow 260 hours to some new graduate nurses (Job Number 2) that may require more extensive training based on prior education and work experience. Substantial Contribution Substantial Contribution provisions do not apply. SLMC is a repeat contractor with payments earned and pending payments potentially in excess of $250,000 within the past five years at its two facilities in Los Angeles and Rosemead (see Active and Prior Projects below) but has not exceed the per facility amount of $250,000. ETP Single (08/16/12) 5 of 7

6 RECOMMENDATION Staff recommends approval of this proposal including wage and hour modifications. ACTIVE PROJECTS The following table summarizes performance by SLMC under an active ETP Agreement: Agreement No. Approved Amount ET $249,480 Term 06/30/11 06/29/13 No. Trainees (Estimated) No. Completed Training No. Retained TBD All training ended March 29, To date, no final payment invoices have been submitted; however, based on the delivery of 12,326 hours to 231 trainees, the Contractor projects a 97% completion rate The Contractor informed ETP that the closeout invoice will be submitted on or before June 15, PRIOR PROJECTS The following table summarizes performance by SLMC under an ETP Agreement that was completed within the last five years: Agreement No. Location (City) Term ET * Los Angeles 07/07/08 07/06/10 Approved Amount Payment Earned $ (%) $475,200 $31,419 (7%) *original Contractor was City of Angels Medical Center In late 2008, SLMC purchased Intercare Health Systems, Inc. dba City of Angels Medical Center, a company beset by severe legal, operational, and financial difficulties coupled with a declining customer base. The hospital name changed; new staff started to rebuild the business; and the new owner assumed all of the rights and obligations of the ETP Agreement. ETP training was sporadic and earnings were low due to the circumstances surrounding the hospital s change in ownership, which triggered a re-organization in management staff, three massive layoffs, and the departure of the Chief Executive Officer and ETP contract representative in early Despite the problems, SLMC managed to complete training and retention for 24 workers. The new owners focused on three key areas to revitalize the business: Leadership: hiring strong, capable leaders with years of experience to create the environment for a complete turnaround; Finance: cutting costs and increasing revenues; and Quality and Service: making quality improvements and introducing new services. Although the company turnaround was an on-going effort in a fragile economy, substantial strides to stabilize and revitalize the business maintained SLMC. The hospital continued to invest in new technologies and expand specialty services. In the first part of 2011, the hospital had only 85 nurses. Today, it employs over 400 full and part-time nurses, is experiencing growth in key areas, and has 100% patient occupancy rates in some areas. Measured by current contract performance (see above), it is evident that SLMC s improvement measures have succeeded. ETP Single (08/16/12) 6 of 7

7 DEVELOPMENT SERVICES SLMC retained National Training Systems, Inc. in Ladera Ranch to assist with development of this proposal for a flat fee of $14,989. ADMINISTRATIVE SERVICES SLMC also retained National Training Systems, Inc. to perform administrative services in connection with this proposal for a fee not to exceed 13% of payment earned. TRAINING VENDORS To Be Determined ETP Single (08/16/12) 7 of 7

8 Silver Lake Medical Center ET Exhibit B: Menu Curriculum Class/Lab Hours Trainees may receive any of the following: MEDICAL SKILLS TRAINING DIDACTIC Acute Psychiatric Care Acute Myocardial Infarction Advanced Cardiac Life Support (ACLS) Arterial Blood Gas (ABG) Interpretation Behavioral Health Nursing Basic Life Support (BLS) Body Mechanics Care of Bariatric Patient Care of the Cardiac Patient Care of the Burn Patient Care of the Neurosurgical Patient Care of Pediatric Patients Care of the Stroke Patient Central Lines Management Chest Tube Care & Management Code Blue Response & Procedures Critical Care Nursing Decontamination Procedures Diabetes Care & Management Dysrhythmia Recognition & Interpretation Educating the Patient & Family EKG & Cardiac Monitoring Electronic Fetal Monitoring (Beginning & Advanced) Equipment Skills (IV Pumps, Cardiac Telemetry, Vital Signs, Pulse-Oximeter, Ventilators, Specialty Beds and Mattresses, etc.) Evidence Based Practices Gastrointestinal Assessment and Management Hemodynamic Monitoring Infection Control Intra-Aortic Balloon Pump Therapy (IABP) Intra-Cranial Pressure Monitoring & Ventriculostomy Intravenous (IV) Insertion & Therapy Kinetic Therapy Medical/Surgical Nursing Medication Administration & Management Moderate Sedation New Graduate Nursing Nurse Orientation Training Nursing Diagnosis Nursing Process Oncology Nursing ETP 100 Exhibit B Menu Curriculum (02/13/12) 1 of 4

9 Silver Lake Medical Center ET Orthopedic Nursing Ostomy & Continence Care Outpatient Nursing Skills Pain Management (Acute & Chronic) Palliative Care Patient Fall Prevention Pediatric Advanced Life Support (PALS) Peri-Operative Nursing Pharmocokinetics PICC Line Insertion Pre and Post Operative Care Psychiatric Nursing Psychotropic Medications Radiology Services Rapid Response Renal Assessment & Management Respiratory Assessment & Care Restraints S.T.A.B.L.E. Telemetry Nursing Total Parenteral Nutrition (TPN) Transfer Techniques Triage Nursing Ventilator and Tracheotomy Care Wound & Skin Care MEDICAL SKILLS TRAINING CLINICAL PRECEPTOR Behavioral Health/Psychiatric Acute Care Services Unit Acute Psychiatric Care Behavioral Health Nursing Outpatient Care Partial Hospitalization Care Electroconvulsive Therapy (ECT) Care of Pediatric/Adolescent Psychiatry Patient Intensive Care Unit/Critical Care Unit Training Critical Care Nursing Intra-Aortic Balloon Pump (IABP)Therapy Intracranial Pressure Monitoring & Ventriculostomy Hemodynamic Monitoring Pre and Post Operative Care Care of Trauma Patient Management of the Renal Transplant Surgical Patient ETP 100 Exhibit B Menu Curriculum (02/13/12) 2 of 4

10 Silver Lake Medical Center ET Ventilator & Tracheotomy Care Long Term Care Unit (Subacute, Skilled Nursing, Transitional Care & Hospice) Geriatric Nursing Med/Surg Nursing Pre and Post-Operative Care Orthopedic Nursing Oncology Nursing Hospice Nursing Medical/Surgical Unit Training Medical/Surgical Nursing Pre and Post Operative Care Orthopedic Nursing Management of the Renal Transplant Surgical Patient Oncology Nursing Operating Room and Post-Anesthesia Care Unit (PACU) Training GI Lab Services Surgical Technician Skills Peri-Operative Nursing Pre and Post Operative Care Pharmacy Services Pharmacy Technician Skills Pharmacist Skills Infection Control Medication Reconciliation & Management Pharmokokinetics Radiology Services Unit Radiology Technique Ultrasound Technique MRI CT Scan Rehabilitation Services Unit Training Medical/Surgical Nursing Pre and Post-Operative Care Post-Orthopedic Surgery Nursing Post-Trauma Injury Nursing ETP 100 Exhibit B Menu Curriculum (02/13/12) 3 of 4

11 Silver Lake Medical Center ET Post-Neurological Injury Nursing Telemetry Unit Training Care of the Cardiac Patient EKG & Cardiac Monitoring Dysrhythmia Interpretation Telemetry Nursing Pre and Post Operative Care Care if the Neurosurgical Patient Intravenous (IV) Therapy Oncology Nursing Urgent Care Services Emergency Room Nursing Emergency Care of the Burn Patient OB Trauma Trauma Nursing Triage Nursing Care of Pediatric patients CONTINUOUS IMPROVEMENT Case Management/Discharge Planning Charge Nurse Training/Frontline Leadership Communications Skills Conflict Resolution CORE Measures Crisis Prevention Intervention (CPI) Critical Thinking Culturally Appropriate Care Customer Service Documentation Lean Six Sigma Organization and Time Management Patient and Family Centered Care Preceptor Skills (Train-the-Trainer) Performance and Quality Improvement and Procedures Team Building Utilization Review COMPUTER SKILLS Microsoft Office/Excel (Intermediate and Advanced) PYXIS Electronic Medical Records Application Note: Reimbursement for retraining is capped at 200 total hours for Job Number 1 and 260 total hours for Job Number 2 per-trainee, regardless of method of delivery. ETP 100 Exhibit B Menu Curriculum (02/13/12) 4 of 4