Public Health Administration Health Systems and Infrastructure Administration Fiscal 2016 Budget Overview
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1 Public Health Administration Health Systems and Infrastructure Administration Fiscal 2016 Budget Overview Van T. Mitchell, Secretary Laura Herrera Scott, M.D., M.P.H., Deputy Secretary 1
2 Public Health Administration Organizational Chart Deputy Secretary Public Health Services Laura Herrera Scott Acting Chief of Staff Jennifer Barnhart Executive Associate 24 Local Health Departments Acting Policy Analyst Vital Statistics Administration Isabelle Horon Laboratories Administration Robert Myers Prevention and Health Promotion Administration Michelle Spencer Office of Preparedness and Response Sherry Adams Office of the Chief Medical Examiner David Fowler Health Systems and Infrastructure Administration Anatomy Board RonnWade Deers Head and Western Hospital Centers
3 Health Systems and Infrastructure Administration (HSIA) Russ Montgomery, Ph.D., M.S. Director, Office of Population Health Improvement
4 State Health Improvement Process Purpose To enable communities to identify critical health needs and implement evidence-based strategies for change while measuring success through a common platform. Local action occurs through Local Health Improvement Coalitions that cover all Maryland counties targets surpassed: Infant mortality Teen birth rate Childhood and adult obesity Youth tobacco use Alcohol-impaired driving fatalities HIV infections Domestic violence Unhealthy air days Affordable housing options Children receiving annual checkup Children receiving dental care Heart disease and cancer mortality Alzheimer s related hospitalizations Significant improvement: Low birth weight Sudden unexpected infant death Entering Kindergarten ready to learn high school graduation rate Adult smoking Life expectancy Children with high blood lead levels Pedestrian injuries on public roads Salmonella transmission through food Proportion with health insurance Drug overdose deaths Seasonal flu vaccination
5 Health Systems and Infrastructure Administration: Programs Public Health Accreditation Purpose: National accreditation improves the quality of practice and performance at Maryland s 24 local health departments and DHMH. OPHI provides technical assistance throughout the process. Progress: LHDs--2 accredited, 6 in process, 11 actively working on applications. DHMH-- process should be complete in 6-8 months Core Local Health Funding Purpose: To provide a high quality, effective public health system funded with State and local resources to support prevention, provide protection and promote health for all Marylanders. Progress: OPHI conducting quality improvement project to streamline grant administration processes, establish common set of local performance measures, and align with State Health Improvement Process
6 Health Systems and Infrastructure Administration: Programs School-Based Health Centers Progress: From Jul 13 to Dec 14: Increase from 70 to 82 SBHCs. In school year, ~30,000 students were enrolled, a 20% increase from Sustainability: Currently, 93 percent of SBHCs are Medicaid providers and the remaining centers have pending applications. DHMH surveys SBHCs to assess need for technical assistance/training, service expansion, and reimbursement School Immunization New requirements in 14-15: Two doses of Varicella vaccine for entering Kindergarten; single dose of Tdap vaccine and a single dose of MCV4 vaccine for entering 7th grade Progress: Technical assistance and consultation with LHDs resulted in a 97 % reduction in noncompliance from announcement of new requirements to beginning of school year.
7 Specialty Hospital Centers Mona K. Gahunia, D.O. Chief Medical Officer, DHMH Deer s Head Hospital Center Western Maryland Hospital Center
8 Program Description Provides care and treatment to individuals in programs under two levels of care: LTCH or Chronic Hospital & CCF or Skilled Nursing Home Services Long Term Care (Chronic) Hospital Intensive medical care & rehabilitation to medically complex patients requiring frequent physician intervention and rehabilitation services. Comprehensive Tuberculosis KDU- Care Facility Skilled nursing services & rehabilitation to community residents including those under 50, and those without any means of payment. In-Patient Treatment Program Long term care & rehabilitation for those patients with TB until medically cleared by Public Health.. Hemodialysis Clinic Provides Hemodialysis to community and CCF residents with End Stage Renal Disease as well as DHHC s LTCH in-patients with Acute Renal Failure
9 .
10 Electronic Medical Record Laboratory interface initiated with in-house vendor for full integration of lab values within the EMR Health Safety Management Team Lifting & strain injuries tracked, FY14 Time lost reduced by 300 hours via awareness & education KDU Implemented ice cream protein product given post treatment Improved blood albumin levels & ability to fight off infections. 5 Diamond Certification- in the Mid-Atlantic Renal Coalition s Patient Safety Program (highest rank) Office of Health Care Quality Successful licensing survey, October 2014 Fair and Just Culture Improve communication, accountability, & sense of fairness Personnel Engagement Survey Majority of the workforce engaged Areas for improvement include recognition, advancement/development, & communication/ involvement in decision making Annual Turnover Rate - 11% Completed & Ongoing Projects Completed Projects North Elevator Project North 1 Asbestos Abatement Project Projects for Completion FY15 Removal of 10,000 Gallon Fuel Tank
11 Western Maryland Hospital Center (WMHC) Program Description Provides care and treatment to individuals in four programs under two levels of care. Services High Intensity Medical Program - Provides intensive medical care and rehabilitation to medically complex patients requiring frequent physician intervention and rehabilitation services. Comprehensive Brain Outpatient Care Program Provide skilled nursing services, rehabilitation, and ventilator management to community residents requiring those services, including those under 50, and those without any means of payment. Injury Rehabilitation Program Provides acute rehabilitation for those returning home and transitional care for those accessing the Brain Injury Waiver Program. Hemodialysis Clinic Provides Hemodialysis to community residents with End State Renal Disease as well as WMHC s Nursing Home residents and Hospital inpatients with Acute Renal Failure.
12 0 00% 10% Western Maryland Hospital Center Providing High Quality Care Quality as a core value High Quality Care Performance Improvement (PI) program: Measures & analyzes 50 + individual quality indicators (QI) QIs reviewed monthly by PI committees & Senior Leadership QIs reviewed quarterly by Governing Body PI committees develop plans of actions for indicators below established thresholds Medication error rate dropped since implementation of the emar/etar & CPOE (0.04% ; 332 errors out of 746,542 doses) Pressure Ulcer Rate Pressure ulcer development considered an indicator for quality of care Implemented a Pressure Ulcer Prevention Program FY % 0.10% 0.08% 0.06% 0.04% 0.02% 0.00% 0.10% 0.08% 0.06% 0.04% 0.02% 0.00% 0.11% Medication Error Rate 0.05% 0.04% FY 2012 FY 2013 FY 2014 FY 2012 FY 2013 FY 2014
13 Western Maryland Hospital Center Programs Established In-Patient Clinics Podiatry Dentistry Optometry Gynecology Wound Care Added Substance Abuse component to the Brain Injury Program Fully Implemented Electronic Health Record Accomplishments Technology/IT Implemented ABAQIS Quality Management Software for Long Term Care Introduced PolicyStat State of the Art Policy Management Software Purchases Lippincott Procedures & Solutions Up to date Nursing Procedures & Training Software Management Developed 3 year Strategic Plan CARF 3 year Accreditation of Brain Injury Program Deficiency-Fee Dialysis Survey Clinical Reduced Urinary Tract Infections by 50% Reduced patients reporting sever to moderate pain by 46% Reduced nosocomial pressure ulcer rate by 50% Implemented FiberOptic Endoscopic Evaluation of Swallowing (FEES)
14 Department of Health and Mental Hygiene Public Health Administration M00F Response to Recommended Actions Health Systems and Infrastructure Administration M00F0201 Amount Position Recommended Actions # 1: Reduce 9.0 positions and Reduction Reduction reduce federal funds for the State Innovation Models $7,022,750 FF 9.0 grant down to the appropriate level. Response: The Administration concurs with this recommendation. Recommended Action # 2: Strike the following language to the special fund appropriation:, provided that this appropriation shall be reduced by $7,841,378 contingent upon the enactment of legislation reducing the required appropriation for Core Public Health Services Response: The Administration concurs with this recommendation. Amount Position Recommended Actions # 3: Reduce general funds Reduction Reduction for Core Public Health Services to the fiscal 2014 level $7,841,378 GF as provided in the Governor s budget. Total Reductions $14,864, Total General Fund Reductions $7,841,378 Total Federal Fund Reductions $7,022,750 Response: The Administration concurs with this recommendation.
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